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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304206318
Report Date: 11/15/2023
Date Signed: 11/15/2023 04:42:22 PM


Document Has Been Signed on 11/15/2023 04:42 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:RODRIGUEZ, MARIAFACILITY NUMBER:
304206318
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 549-3047
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:14CENSUS: DATE:
11/15/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:TIME COMPLETED:
05:00 PM
NARRATIVE
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On 11/15/23 at 1:10PM, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 3 Year inspection assisted by licensee Maria Rodriguez. Upon arrival, the licensee had 5 clients in care, including 2 infants and 3 school age children. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

INDOOR INSPECTION. The LPA inspected the indoor family day care area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care by means of child gates and locks at the time of inspection. The child care area, consists of the play room, living room, and one bedroom. Upon arrival, the LPA took census and observed one child (C2) sleeping in a off-limits bedroom with the door closed. The licensee was unable to visually observe C2 without moving the door. (See 809D). According to CCR, if an 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.

The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The licensee agrees to maintain telephone service in the home when clients are in care. Hours of operation are 24Hrs. seven days per week. The licensee understand that a child must not remain in the day care for 24 hours or more. The licensee is aware that each family day care shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was documented on 11/05/23. There is no fireplace in the facility.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/15/2023 04:42 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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 records review, the licensee did not comply with the section cited above in 2 of 2 infants present, which poses an immediate health, safety or personal rights risk to persons in care. The LPA observed NO 15 minutes safe sleep check in file for either of the two infants present during the inspection. When asked, the licensee stated she does not do the 15 minute safe sleep checks for infants.
POC Due Date: 11/16/2023
Plan of Correction
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The licensee stated she will conduct and documenting the 15 minutes safe sleep checks for all infants (children 24 months and younger) and send a copy to the LPA on 11/22/23 and again no later than 12/06/23 via email. Email was provided to the licensee. A sample safe sleep log was provided to the licensee.
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, the licensee did not comply with the section cited above in 1 of 2 infants, which poses an immediate health, safety or personal rights risk to persons in care. Infant C2 was sleeping in an off-limits bedroom with the door closed. The licensee was unabvle to visually observe the infant without moving the door.
POC Due Date: 11/16/2023
Plan of Correction
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The child was removed from the bedroom while the LPA was in the facility. The licensee stated she will allow children in the off-limits areas and instead use the living room which is part of the day care. The licensee will send a written statement to the LPA declaring that she will not use the off-limits areas.
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: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/15/2023 04:42 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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

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 in 2 of 2 play houses, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed spiderwebs in two playhouses in the backyard. The webs had gathered dry leaves and grassy material and dust showing the webs have been there for some time. The licensee stated the children play outside when it's sunny.
POC Due Date: 12/06/2023
Plan of Correction
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The licensee stated she will remove the spider webs and ensure there are not spiders in the outside play equipment. The licensee will send picture of the cleaned equipment by 12/06/23 to the LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318
VISIT DATE: 11/15/2023
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The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. Clients nap mats or play yards. According to the licensee, beddings are stored individually was washed weekly. The facility provides age-appropriate toys, play equipment, and materials for the clients served.

ON-SITE FOOD PREPARATION: The licensee provides food to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the LPA observed spider webs on the outside play equipment, which poses a potential risk to the health and safety of children in care (See 809D). The licensee stated the children play outside when the weather permits. There were no bodies of water (in-ground pool/ jacuzzi/ community pool/water fountain) in the facility at the time of inspection.

PERSONNEL RECORDS: Personnel records were reviewed for compliance. The licensee and her assistant have a current MR in file. The licensee has a current Pediatric CPR and Pediatric first aid in file approved by the American Heart Association.

CHILDRENS’ RECORDS: The licensee has a current roster of clients. The LPA reviewed the children’s records for compliance. The roster shows there are two infants enrolled in the family day care. The LPA reviewed LIC 9227 Individual Infant Sleeping Plan for two infants. There were no 15-minute check logs for two infants. The licensee stated she does not physically conduct the 15-minute safe sleep check (see 809D). A sample safe sleep log was provided to the licensee. The LPA explained what the 15 minutes checks are and what to look for.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318
VISIT DATE: 11/15/2023
NARRATIVE
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The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The licensee understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a qualified substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

The licensee understands that 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318
VISIT DATE: 11/15/2023
NARRATIVE
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The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/
  1. LPA reviewed the following safe sleep best practices with the licensee:
  2. Always place infants 12 months and younger on their backs to sleep
  3. Use only a tight-fitting sheet on the crib or play yard mattress
  4. Do not hang any items from the crib or above the crib
  5. Keep all items including blankets, pillows, and stuffed dolls out of the crib or play yard
  6. Pacifiers may be used only if they do not have items attached to them and there is no recall
  7. Infants should not be swaddled or have any items covering them while sleeping
  8. The temperature of the room should be comfortable enough for a lightly clothed adult
  9. Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
  10. Conduct and document the 15-minute checks for all infants under 24 months
  11. CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.

The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102425(j) Infant Safe Sleep, 102425(j)(5) Infant Safe Sleep, 102417(d) Operation of A Family Child Care Home.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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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: RODRIGUEZ, MARIA
FACILITY NUMBER: 304206318
VISIT DATE: 11/15/2023
NARRATIVE
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LPA A. Silva informed licensee Maria Rodriguez that this licensing report dated 11/15/23 documents tw “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensee Maria Rodriguiez that:
  1. A copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care.
  2. A copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report.
  3. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the child's file for verification of receipt of the report.

The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was posted and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. 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.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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