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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370195
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:59:24 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:KIDWORKSFACILITY NUMBER:
304370195
ADMINISTRATOR:GALDAMEZ, IDALIAFACILITY TYPE:
850
ADDRESS:1902 WEST CHESTNUT AVENUETELEPHONE:
(714) 834-9400
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:24CENSUS: 19DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Director Idalia GaldamezTIME COMPLETED:
01:15 PM
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A case management inspection was conducted on this date by Licensing Program Analyst (LPA) Barajas in response to a self reported incident received in our office on 01/17/2020. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

LPA met with Director Idalia Galdamez and discussed the unusual incident report in which a child disclosed to Parent that personal rights may have been violated. On 01/13/2020 child disclosed to the mother child was inappropriately touched. LPA on today’s date requested a copy of Children’s Roster (LIC 9040), Facility Personnel Report (LIC 500), Sign in Sign out sheets for 01/13/2020 through 01/17/2020, Medical Report, took pictures and requested a copy of the surveillance video.

This unusual incident will be investigated by Investigator T. Smith from Investigation Branch (IB). Investigator Smith will be conducting interviews, and requesting documents as needed.

Due to insufficient information available at this time this incident requires further investigation. Further interviews and record reviews will be conducted.

There were no Title 22 deficiencies observed and/or cited during today's inspection.

Exit interview was conducted. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights were provided and explained.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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