304313756-2-18-2021-06-CC-ECOL-BYCRW5-20210218122234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313756
Report Date: 02/18/2021
Date Signed: 02/18/2021 12:22:56 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:	VILLA DE VALDOVINOS, YEIMI		FACILITY NUMBER:	304313756
ADMINISTRATOR:	VILLA DE VALDOVINOS, YEIMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 785-6041
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	14	CENSUS: 8	DATE:	02/18/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee - Yeimi VIlla De Valdovinos		TIME COMPLETED:	12:15 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	Licensing Program Analyst (LPA) Corral conducted an unannounced Case Management-Licensee Initiated Tele-Inspection. Licensee’s submitted a written request to add a bedroom for day care use, the bedroom is located in the far right of the home. During the Tele-Inspection LPA Corral met with Licensee, Yeimi VIlla via Zoom application. LPA notified the Licensee that due to COVID-19 and Department of Public Health (DPH) guidelines of Social Distancing a Tele-Inspection would be conducted. The COVID-19 Emergency Response questionnaire was reviewed. During Tele-Inspection there were 8 children with 2 staff present in the facility. A review of the Facility Personnel Report Summary on 02/18/2021 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA Corral conducted a walk-through of the home via Zoom and provided resources related to COVID-19 via email such as Fun Flyers for Children that demonstrate how to slow the spread of COVID-19, how to properly wear a mask, how to promote social distance, and also Step by Step Cleaning and Disinfecting. All areas identified on the Facility Sketch were inspected by LPA Corral via Zoom. The bedroom requested to be added is located in the far right of the home. The bedroom is accessible to children in care by the hallway located in the kitchen. The hallway has three doors, the first door to the right is the laundry room which is inaccessible to children by a lock and key. The second door to the right is the bathroom which is accessible to children. The third door is straight down the hallway which is the room requested to be added to the Facility Sketch as available to children in care. Licensee stated the requested room will be used as the napping room. During the Tele-Inspection the bedroom requested to be added was clean and empty. Licensee stated she will bring 2 cribs and cots once the room is approved for use. Licensee stated she is requesting this room to be added as accessible to children in care to honor the Public Health Department recommendation of Social Distance. Continue to LIC 809C, Page 2.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILLA DE VALDOVINOS, YEIMI	FACILITY NUMBER: 304313756
	VISIT DATE: 02/18/2021

NARRATIVE

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Page 2
Based on today's Tele-inspection, the room requested to be added as additional space for children in care has enough activity space to support licensee’s request. The requested room was evaluated, and deficiencies were not observed. Facility is in compliance of CA Code of Regulations, Title 22, and Division 12. Facility meets all licensing requirements and file will be submitted for approval. Licensee was advised that any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The Notice of Site Visit was not posted due to tele-inspection COVID-19 State of Emergency. Appeal Rights were explained. A copy of Appeal Rights will be provided via email and signature on this report acknowledges receipt of these rights. Licensee will respond to email acknowledging Appeal Right and Report was received. Licensee was informed first level of appeal is to Regional Manager. Exit interview was conducted.

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: 02/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021

LIC809 (FAS) - (06/04)

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