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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310373
Report Date: 04/17/2024
Date Signed: 04/17/2024 01:17:22 PM


Document Has Been Signed on 04/17/2024 01:17 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:RAMIREZ DE HERNANDEZ,YADHIRAFACILITY NUMBER:
304310373
ADMINISTRATOR:RAMIREZDEHERNANDEZ,YADHIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 791-1114
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:14CENSUS: 10DATE:
04/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Oscar HernandezTIME COMPLETED:
01:25 PM
NARRATIVE
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On 4/17/2024, Licensing Program Analysts (LPA) A. Silva conducted a Case Management – Deficiencies due to deficiencies observed during a visit. Upon arrival, the LPA meet with Oscar Hernandez. An on-site Facility Personnel Report Summary review indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Census 10 children including four infants, three of which were under 12 months of age. The facility was operating within ratios and capacity.

Per CCR 102425(b) Infant Safe Sleep, cribs or play yards shall be free from all loose articles and objects. Safe sleep regulations were discussed with the licensee during a previous visit on 1/11/24. During today’s visit, the LPA observed loose blankets and articles inside each of the four cribs. Three of the cribs were occupied by an infant under 12 months of age each. Assistant Dora removed the blankets and loose articles from the cribs immediately.

Based on observation, the facility is being cited in accordance with the California Code of Regulations, Title 22, Division 12, for the following section: CCR 102425(b) Infant Safe Sleep.




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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
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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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: RAMIREZ DE HERNANDEZ,YADHIRA
FACILITY NUMBER: 304310373
VISIT DATE: 04/17/2024
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LPA A. Silva informed licensee Oscar Hernandez that this licensing report dated 4/11/2024 documents one “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 the daycare representative that 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, 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, and signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the infant's file for verification of receipt of the report.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and 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. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with the daycare representative.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/17/2024 01:17 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: RAMIREZ DE HERNANDEZ,YADHIRA
FACILITY NUMBER: 304310373

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/17/2024
Section Cited
CCR
102425(b)

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102425(b) Infant Safe Sleep. (b) Cribs or play yards shall be free from all loose articles and objects.

The licensee did not meed the regulation above as evidenced by:
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Oscar Hernandez stated they will inform to the parents to not bring blankets to the daycare anymore. In the event that a blanket is left behind, the blanket will be stored in the child's cubie.
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Based on observation, the licensee did not meet the regulation above in 4 out of 4 cribs, which poses an immediate risk to the health and safety of infants in care. LPA observed 4 cribs with loose articles inside. Three cirbs had one infant under 12 months inside.
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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: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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