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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304205587
Report Date: 03/27/2023
Date Signed: 03/28/2023 01:26:32 PM


Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:MALTESE, ROWENAFACILITY NUMBER:
304205587
ADMINISTRATOR:MALTESE, ROWENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 412-8165
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY:14CENSUS: DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Maltese Rowena TIME COMPLETED:
04:30 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Mrs. A. Bootorabi.

Census upon entry:
Infants: 3
Children Over Two: 9
Adults Working Directly with Children: 1
Other Adults: 1
Other Children 12+: 1 (Licensee Son)

During today’s inspection, LPA was greeted by assistant #1 who was in the front yard outside with neighbors upon LPA's arrival .Assistant #1 was not engaging or supervising any children upon LPAs arrival at 1:03 pm. LPA confirmed that a child care was being operated by assistant #1 and was guided to the front door. Upon entry assistant #1 guided LPA to the kitchen where licensee was holding an infant and caring for 11 children.

An Entrance Checklist (LIC 126) was provided to the licensee Rowena Maltese upon arrival. Licensee stated she needed to put the children down for a nap and LPA expressed for licensee to take her time while she set up. LPA asked for records for review at this time if it was possible for review while licensee cared for the children. During this time the kitchen's doors were open that led to the backyard where toys and swings were observed.



SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 14


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587
VISIT DATE: 03/27/2023
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While licensee was with children in the day care room the LPA asked Assistant #1 if he could test carbon monoxide and fire alarm detectors before children settled in. Assistant #1 was not engaged with children at this time and was able to test both alarms. Both were tested and met requirements.

Once Licensee return a tour of the facility began. The facility sketch (LIC 999) was reviewed with the licensee to confirm areas of care. Licensee stated room #1 next to the living room had one child sleeping. The LPA confirmed the room and informed the licensee she had removed that room in 2015 in an updated sketch. Licensee admitted to the changes and that she did not update licensing office when the room was added.

The LPA and licensee toured room #1. The licensee opened the door where a infant was sleeping at the end of the room. The room door was closed and in front of the door was a large floor fan that was on. The room was dimmed due to windows blocking light and floor fan created a strong noise. The playpen was observed to have blankets around the wall of the playpen. The LPA informed licensee that children could not be left alone in rooms with closed doors. The licensee stated she closes doors because then children wake up. The infant was sleeping on their back, with a sleep sack and pacifier. The LPA discussed doors being open while children are sleeping to provide adequate supervision and hearing children if they wake up.

The licensee and LPA continued the tour to room #2 where two children were napping with a closed door. Room #2 was dark and is next to the day care room. Children were observed napping in play pens. The licensee confirmed that one child was an infant and one was over two.

The licensee and LPA toured the day care room. The day care room had 7 children resting on the floor on mats and blankets. Children were not feet apart and one child was observed sitting on the coach.

The LPA verified that the following documents were posted in a prominent, publicly accessible area; License, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness. The licensee was not in compliance upon review. LIC 9148 Earthquake Preparedness was not posted during today's inspection.


The Facility Day care hours are 7:30 am-5 p m, Monday through Thursday.
Page 2
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587
VISIT DATE: 03/27/2023
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During the inspection of the indoor activity space, items that could pose a danger to children detergents, cleaning compounds, and medications were observed to be stored out of the reach of children. The LPA observed Poisons/Hazardous Items (detergents, cleaning compounds, and medications) out of reach of children in care by means of being stored up high in cabinets children cannot reach.

The LPA requested to review the LIC 610A Emergency Disaster Plan, Verification of Disaster and Fire Drills, and LIC 9040 Facility Roster. The LIC 610A was verified by the backdoor. Verification of Disaster and Fire Drills were verified and did not meet requirements. The last drill was conducted on 1/17/22 9:30 am.

The LPA requested completed personnel records for licensee and assistant #1 for review during today’s inspection. The following documents were reviewed in the files provided by the licensee; CPR First Aid Certification, LIC 9052, Immunization records, TB clearance and LIC 9108, and a Mandated Reporter Training Certificate. Licensee's CPR & First Aid training expire on 07/21/2023. The file for licensee and assistant did not meet requirements. There was not a separate or complete file for each adult working with the children. CPR, First Aid and Immunization's were verified. Mandated reporter is expired.

Children’s Records Reviewed at 2:22 pm .The LPA requested completed children’s records of children enrolled. Children's records were reviewed, and there was a separate record for each child. The LPA reviewed files to verify the following documents Immunization Records, LIC 700 Identification, Emergency Medical Treatment and , LIC 995A Notification of Parents’ Rights. Licensee did meet the requirements for completed files. Licensee is missing original immunization records for children and a consultation was provided to obtain original immunization's.

www.myvaccinerecord.cdph.ca.gov

Individual Sleep Plans and Sleep Logs were request at 3:05 pm. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and maintained at the facility in the infant’s file. LPA requested for review LIC 9227 Individual Infant Sleeping Plan and sleep logs. The licensee did not meet requirements and is out of compliance.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587
VISIT DATE: 03/27/2023
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Safe Sleep consultation was provided 3:13 pm.The LPA and Licensee toured the infant napping areas and observed blankets hanging in the play pens. Other children napped in the matts in the day care room.

During today’s inspection, the licensee and LPA discussed the following:

- Stay up to date with LIC 9227 and discuss with parents any new changes


- Ensure 15 min checks are conducted & logged (The initial of the person checking should be included)
- The importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
- Always place infants on their backs to sleep
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from the crib or above the crib
- Keep all items, including blankets, out of the crib or play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
The following are additional resources.
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
The American Academy of Pediatric https://www.aap.org/en/patient-care/safe-sleep/
Safe Sleep Regulations https://cdss.ca.gov/Portals/9/Additional-Resources/Legislation-and-Regulations/Public%20Hearing%20Docs/f031803RegulationsTextOALfinal.pdf

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are 2 adults including the licensee and 1 minor child living in the facility. The licensee was reminded that any individuals 18 years or older must have a background check clearance. The licensee was also reminded that any children turning 18 years must obtain a background check to maintain compliance.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587
VISIT DATE: 03/27/2023
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The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training.

The LPA discussed with the licensee that they will return the following day to continue inspection.
The LPA provided the licensee with infant safe sleep regulation and Safe Sleep flier. The LPA discussed with licensee that if they had any questions about the information provided the licensee and LPA could discuss the next day

End of Report for 3/27/2023

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587
VISIT DATE: 03/27/2023
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 Areas stated to be off-limits by the facility sketch were made off limits by baby safe gate outside and baby safe gate between the kitchen and living room. The cabinets in the kitchen had baby safe locks.

The outdoor play area consist of two sheds. Shed #1 is used as a play area and storage at the end of the day Items in the shed consist of toys and other large children items. Licensee was consulted on this matter due to some items being a danger to children playing in that area. Shed #2 cannot be locked and has a sliding door. Items in the shed are house hold items that pose a risk of health and safety. The LPA consulted licensee on the importance of supervision and ensuring children do not access that area.

The outdoor area had 3 swings. Children were observed falling asleep in the swings outside. The LPA observed highchairs in the kitchen where children are placed to eat. Children were observed falling asleep on highchairs during the inspection. The LPA reminded licensee "(i) If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible."

Meals are prepared for the children in care by the licensee. Water bottles were not observed to be labeled and licensee was consulted. Licensee stated that there are no children with allergies enrolled at this time.

Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. The children's bathrooms are clean and sanitary. Children nap on mats and bedding is stored individually in each bed or stored in the day care closet. The licensee washes blankets at end of the week and some blankets are taken home by the parents to clean if they provide them. All soiled blankets and clothing are washed right away stated by the Licensee.

The licensee stated the children's primary care and play areas consist of the outdoor area and day-care room. The home has age-appropriate toys for the ages served and a consultation was provided.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was maintained and free of dangerous hazards to children.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 6 of 14
Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
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Based on observation, and interview the licensee did not comply with the section cited above due to blankets being oberved on the sides of the play pens the children nap in which poses an immediate health and safety risk to persons in care.
POC Due Date: 03/28/2023
Plan of Correction
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The licensee removed the blankets from the cribs during the inspection.
Type A
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above due to children napping in rooms with closed doors and no sleep logs available for review which poses an immediate health and safety risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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The liensee will begin sleep checks and submit proof to LPA via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 7 of 14


Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by means of children napping in rooms with closed doors where children can not be visually supervised which poses an immediate health, and safety risk to persons in care.
POC Due Date: 03/28/2023
Plan of Correction
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The licensee will be leaving the door open where children are napping. The licensee will also review the infant safe sleep regulations.
Type A
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above due to not having the documents to meet the requirements which poses an immediate health and safety risk to persons in care.
POC Due Date: 04/04/2023
Plan of Correction
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The licensee will have parents sign the LIC 9227 by parents and submit documents to licensee by due date 4/4/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 8 of 14


Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above upon LPA's entry on 3/27/23 when assistant #1 was not supervising or engaging with children enrolled in care which poses an immediate health & safety risk to persons in care.
POC Due Date: 03/29/2023
Plan of Correction
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The licensee stated that moving forward she is going to have her assistant stay in the home when she is caring for children.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 9 of 14


Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on interview and record review, the licensee did not comply with the section cited above due to the last drill being completed in 1/17/2022 which poses a potential health and safety risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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The licensee stated she will complete on this week and sumit it via email.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review, the licensee did not comply with the section cited above due to training being expired for licensee and assistant #1; Training was not verified for assistant #2 at this time which poses a potential health and safety risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
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The license and assists will work on completing this training and will submit certificates via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 10 of 14


Document Has Been Signed on 03/28/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MALTESE, ROWENA
FACILITY NUMBER: 304205587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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2
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4
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
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