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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313756
Report Date: 08/03/2021
Date Signed: 08/03/2021 03:27:53 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, YEIMIFACILITY NUMBER:
304313756
ADMINISTRATOR:VILLA DE VALDOVINOS, YEIMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 785-6041
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:14CENSUS: 10DATE:
08/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Yemi Villa De ValdovinosTIME COMPLETED:
03:45 PM
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On 8/3/21 at 1:25 PM, Licensing Program Analyst (LPA) Hawkins arrived at the facility for the purpose of conducting a case management investigation in regards to a self reported unusual incident report related to a child injury. LPA toured the facility with licensee Yemi Villa De Valdovinos. LPA observed licensee and assistant Stephany Erazo caring for 10 children; which included (3) infants, (5) preschool age, (2) of school age. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are (2) adults (including the licensee) and (2) minor children living in the facility.
During todays case management inspection, LPA interviewed two staff and gathered additional documentation. The unusual incident reported that parent alleged that child sustained unexplained injury while in care at the facility. Child's contact/emergency information was obtained for the purpose of this investigation. LPA Hawkins observed a glass sliding door that is between the living room and the child care room. Children have the ability to open and close door which is heavy and may cause a potential injury to the children in care.
Due to insufficient information at this time the Department will continue the investigation into this unusual incident report and will provide updates.
No deficiencies were observed at the time of the visit. The facility was found to be in compliance with Title 22 regulations. An advisory note was provided.
An exit interview was conducted with Licensee Yemi VIlla Valdovinos on this date. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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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