<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310410
Report Date: 07/01/2025
Date Signed: 07/01/2025 09:55:46 AM

Document Has Been Signed on 07/01/2025 09:55 AM - 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LUPERCIO, GUADALUPEFACILITY NUMBER:
304310410
ADMINISTRATOR/
DIRECTOR:		LUPERCIO, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 604-8516
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/01/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Guadalupe LupercioTIME VISIT/
INSPECTION COMPLETED:
09:55 AM
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 informal office meeting was conducted on July 01, 2025, at the Orange County Regional Office. Licensing Program Manager (LPM) Ho, Licensing Program Analyst (LPA) Silva, and licensee Guadalupe Lupercio and counsel Alan Castillo, Esq., were present at the meeting. The purpose of the informal meeting was to discuss the following violation issued on February 05, 2025.

HSC 1597.467 Injury or acts of violence reporting requirements. (b)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a family day care home of any of the following events.

There was local law enforcement involvement on 9/26/24, which the licensee failed to report to the Licensing Division.

During the meeting, the licensee stated she did not report the incident on 9/26/24 because she assumed that local law enforcement would make the report. The licensee stated that in the future when she receives a report or observes an unusual incident at the Family Child Care Home, she will report to the Licensing Division by phone call and in writing as required by the regulations.

The licensee stated she understands the process for reporting and explained she would call the officer of the day to report any unusual incident within 24 Hrs. and follow up with a written report within seven days.

The licensee was reminded that structural changes to the home that impact the daycare children must also be reported.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2025
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LUPERCIO, GUADALUPE
FACILITY NUMBER: 304310410
VISIT DATE: 07/01/2025
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
A copy of a blank LIC624 Unusual Incident/Injury Report form was provided to the licensee.

The Technical Support Program (TSP) was discussed. A TSP referral flyer was provided to facility representatives. The licensee agreed to participate in the TSP program.

A copy of the Child Care Video Series https://ccld.childcarevideos.org/ handout was provided to the licensee. The licensee agrees to watch 7) Child Care Reporting Requirements and notify the LPA upon completion within 30 days of this meeting.

Upon receipt of this report pertaining to a meeting conducted by a local Licensing Agency in which issues about reporting requirements were discussed, the licensee must: 1) Provide a copy of this report to the parent/guardian of children currently enrolled by the next business day or immediately upon return. 2) A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). 3) Obtain a signature and date from the child's parent/guardian on the Acknowledgement of Receipt of Licensing Reports LIC 9224. 4) Keep a record immediately upon receipt of the completed and signed LIC 9224 acknowledging receipt of this report in the child's file.

Exit interview was conducted with the Licensee, Guadalupe and Alan Castillo, Esq. A copy of this report was provided to the licensee along with a copy of their appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3