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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313293
Report Date: 05/18/2023
Date Signed: 05/18/2023 02:52:06 PM


Document Has Been Signed on 05/18/2023 02:52 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:ESCALANTE, GENESISFACILITY NUMBER:
304313293
ADMINISTRATOR:ESCALANTE, GENESISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 488-2866
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 3DATE:
05/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Genesis EscalanteTIME COMPLETED:
03:10 PM
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On May 18 of 2023 at 12 noon, Licensing Program Analyst (LPA) Archibaldo Silva conducted an unannounced Required – 1 Year inspection assisted by licensee Genesis Escalante. Upon arrival, the licensee and one assistant had 3 preschool clients in care. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios. 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. Five adults, including the licensee currently live in the home.
INDOOR INSPECTION. The LPA inspected the indoor FCCH (Family Child Care Home) area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care with child gates and door locks, at the time of inspection. The facility is a one-story, single-family home. The child care area, which is accessed through double door, consists of two rooms, a bathroom, and the back yard.
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 stated she keeps telephone service in the home when clients are in care. Hours of operation are 7am to 5pm. The licensee is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was not documented (see 809D).
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 on cots. According to the licensee, beddings are washed weekly. The facility provides age-appropriate toys, play equipment, and materials for the clients served.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
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 6


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: ESCALANTE, GENESIS
FACILITY NUMBER: 304313293
VISIT DATE: 05/18/2023
NARRATIVE
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809 Page 2
ON-SITE FOOD PREPARATION: The licensee provides breakfast, lunch, dinner and snacks to the clients in care. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Filtered drinking water is available to clients in care. 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 surface of the outdoor activity area was maintained and free of any observable hazards. There were no bodies of water] (in-ground pool/ jacuzzi/ community pool/water fountain) in the facility at the time of inspection.
PERSONNEL RECORDS: The LPA reviewed three files out of the three staff who were present during the inspection. The LPA observed the mandated reporter certificates were expired (See 809). The Pediatric CPR/First Aid certification expires on 5/2024. Immunization were reviewed for three staff.
CHILDRENS’ RECORDS: The licensee has a current roster of children who are provided care. The LPA reviewed 5 client’s records, including 3 files of children who were present during the inspection. All files reviewed were in compliance and included completed copies of the LIC 700, LIC282, LIC627, LIC995A, and Immunization records. The roster shows there are no infants enrolled in the FCCH.

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

DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ESCALANTE, GENESIS
FACILITY NUMBER: 304313293
VISIT DATE: 05/18/2023
NARRATIVE
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809 Page 3
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

The LPA discussed the following resources with the licensee:
  1. US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
  2. Child Care Advocate Program link: https://cdss.ca.gov/inforesources/child-care-licensing/child-care-advocates
  3. Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
  4. CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
  5. Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
  6. CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
  7. CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: ESCALANTE, GENESIS
FACILITY NUMBER: 304313293
VISIT DATE: 05/18/2023
NARRATIVE
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809 Page 4
LPA reviewed the following safe sleep best practices with the licensee:
  1. Always place infants 12 months and younger on their backs to sleep
  2. Use only a tight-fitting sheet on the crib or play yard mattress
  3. Do not hang any items from the crib or above the crib
  4. Keep loose bedding and soft items like blankets, pillows, and stuffed dolls out of the crib or play yard
  5. Pacifiers may be used only if they do not have items attached to them and there is no recall
  6. Avoid swaddling, overheating, and head covering in infants
  7. The temperature of the room should be comfortable enough for a lightly clothed adult
  8. Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
  9. Conduct and document the 15-minute checks for all infants under 24 months
  10. CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.
  11. The LPA provided two safe sleep brochures for what a safe environment looks like and a sample sleep logs.
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: 1596.8662(b)(1) Administration of Child Day Care Licensing and 102417(g)(9)(A)1 Operation of a Family Child Care Home.
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.
The LPA conducted an exit interview and reviewed the report with the licensee. The Notice of Site Visit was posted. The licensee understands that the Notice of Site Visit 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 at the address listed above.
End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/18/2023 02:52 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: ESCALANTE, GENESIS
FACILITY NUMBER: 304313293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and records review, the licensee did not comply with the section cited above in 1 out of 1 disaster drills, which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee stated she did not document the last drill. LPA reviewed records and observed that a drill has not been documented since 2022.
POC Due Date: 05/30/2023
Plan of Correction
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The licensee stated she will conduct and document a disaster drill and provide proof of correction to the LPA by the due date via email at archibaldo.silva@dss.ca.gov

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: 05/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 05/18/2023 02:52 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: ESCALANTE, GENESIS
FACILITY NUMBER: 304313293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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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Based on observation and records review, the licensee did not comply with the section cited above in 3 out of 3 staff present who require a mandated reporter certificate, which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee stated the certificates had not been updated. LPA observed the available certificates had expired.
POC Due Date: 06/18/2023
Plan of Correction
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The licensee stated that all staff who require a mandated reporter will complete the training by the due date. The licensee will provide proof of correction to the LPA by the due date via email at archibaldo.silva@dss.ca.gov
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: 05/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6