304206318-6-16-2021-06-CC-ECOL-C42UR8-20210616154820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304206318
Report Date: 06/16/2021
Date Signed: 06/16/2021 03:48:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RODRIGUEZ, MARIA		FACILITY NUMBER:	304206318
ADMINISTRATOR:	RODRIGUEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 549-3047
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	14	CENSUS: 5	DATE:	06/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Licensee - Maria Rodriguez		TIME COMPLETED:	04:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An Annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Corral. LPA observed licensee Maria Rodriguez and Ramon Rodriguez (husband) caring for 5 children which included 2 preschool age children and 3 school age children in care. Licensee’s adult daughters were also present in the home during inspection. LPA Corral observed Licensee to be operating within the licensed capacity. LPA Corral reviewed the COVID-19 Emergency Response questionnaire with Licensee. Due to COVID 19 guidelines, LPA Corral observed Licensee and Ramon wearing a face mask and social distancing to comply with CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary conducted on 06/15/2021 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 5 adults including the licensee, husband and 3 adult daughters. Licensee stated she is available to care for children Monday - Friday 7 am - 6 pm and Saturdays. During today’s inspection, LPA Corral toured the inside and outside areas of the Facility identified in the Facility Sketch as accessible to childcare children. All bedrooms are inaccessible to children in care by means of a child gate entering the hallway. The childcare area includes the living room that is used for napping which is accessed through the main entrance of the home. The bathroom is accessible to children which is located in the hallway to the right before the child gate. Licensee stated the children's primary play area is the room located to the right of the kitchen which is used as a play room. The children also use the back yard for play use which has a fence with a playground, tricycles, and age appropriate toys. The facility has a working carbon monoxide, smoke detector, and fire extinguisher that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, and other items which could pose a danger if readily available to children were inaccessible to children in care which are placed in the garage. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. Continue to Page 2.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RODRIGUEZ, MARIA	FACILITY NUMBER: 304206318
	VISIT DATE: 06/16/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2.
The Facility does not have a fireplace or an open-faced heater. The home has age appropriate toys and play equipment for the ages served. The home was observed to be clean and orderly, with heating ventilation for safety and comfort. During today’s inspection LPA observed 2 preschool age children playing in the living room and 3 school age children in the playroom located off the kitchen. Licensee stated she uses her home and cell phone as for a working telephone. Bodies of water were not observed to be present on the premises. Children Roster was reviewed by LPA Corral, Fire and Disaster drill was also in compliance, the last Fire and Disaster Drill was completed 06/14/2021.

The Licensee's Pediatric CPR/First Aid certification expire on 04/2023. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Licensee's proof of immunization against pertussis and measles were not available for LPA review, the licensee does not have proof of immunization against pertussis, and measles. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. Licensee completed Mandated Reporter Training on 06/16/2020 and is in compliance.

** Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The licensee understands she 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 and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
Continue to Page 3.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RODRIGUEZ, MARIA	FACILITY NUMBER: 304206318
	VISIT DATE: 06/16/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 3.
CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. Licensee does/does not have lead training Certificate. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:

Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with licensee the following safe sleep best practices:
- Always place infants on their backs for sleeping
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from 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 to wear a t-shirt and not be too hot or too cold

Licensee was referred to PIN 20-06-CCP Social and Physical Distancing Guidance and Healthy practices for childcare facilities in response to the global coronavirus. Licensee was asked if she was in need of COVID-19 posters and resources, LPA Corral will email flyers, resources and information to Licensee.

The facility was not in compliance and in violation of the California Code of Regulations, Title 22, Division 6, Health & Safety Code, Family Day Care Home, HSC 1597.622 (a)(1).
Continue to Page 4.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RODRIGUEZ, MARIA	FACILITY NUMBER: 304206318
	VISIT DATE: 06/16/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 4
An exit interview was conducted with Licensee Maria Rodriguez, report was also translated and read to Licensee in Spanish. Appeal Rights were explained. The Licensee was provided a copy of Appeal Rights (LIC 9058 01/16) and signature on this report acknowledges receipt of these rights. Licensee was informed all appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed above. The Notice of Site Visit was posted. Licensee was informed Notice of Site Visit must be posted for 30 consecutive days and failure to post will result in civil penalties of $100.00.

End of Report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RODRIGUEZ, MARIA	FACILITY NUMBER: 304206318
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/30/2021 Section Cited	1 2 3 4 5 6 7	HSC 1597.622(a)(1) Commencing September 1, 2016, a person shall not be employed at a family day care home if she has not been immunized against influenza, pertussis, and measles. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA Corral record review, Licensee did not have proof of immunization against pertussis and measles. This poses a potential health risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

Page: 5 of 5