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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334817507
Report Date: 04/26/2021
Date Signed: 04/26/2021 10:56:27 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VALENCIA FAMILY CHILD CAREFACILITY NUMBER:
334817507
ADMINISTRATOR:VALENCIA, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 698-9334
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY:14CENSUS: 4DATE:
04/26/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jessica ValenciaTIME COMPLETED:
11:00 AM
NARRATIVE
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**Please note: Due to COVID-19, a tele-inspection is being conducted in lieu of an in-person/physical inspection***

On 4/26/2021 Licensing Program Analyst (LPA) Samuel Lopez contacted Licensee Jessica Valencia, via FaceTime, to address and conclude an issue previously discussed on March 24, 2021. This Case Management Tele-inspection is being conducted to address a separate issue that was discovered while gathering information during an investigating.

LPA Lopez learned that on March 12, 2021, a child, while in care, suffered an injury that required medical attention however, the licensee failed to report the incident to the Department. The licensee disclosed the incident only after LPA Lopez made contact on March 24, 2021. The regulations, in Title 22, require licensees to report such incidents to the Department, verbally within 24 hours of its occurrence or knowledge, and in writing within 7 days.

The facility was found to be a violation of the following Title 22 regulations:

102416.2 (b) Reporting Requirement: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(3)(C) that occur during the operation of the family childcare home.

See LIC 809-D for cited deficiency

An exit interview was held, and a copy of this report was sent, via email, to Jessica Valencia.

***This report was sent via email on 4/26/2021. Jessica has agreed to reply or to acknowledge that she has received it, via read receipt. This will serve as Jessica’s signature***

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 334817507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2021
Section Cited

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Reporting Requirement: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(3)(C) that occur during the operation of the family childcare home.
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This requirement was not being met as evidenced by the licensee’s failure to report verbally and in writing, via the Unusual Incident Report form (LIC624B), the incident involving a child being injured, which required medical attention. This poses a potential Health, Safety or Personal Rights risk to the children in care.
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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2021
LIC809 (FAS) - (06/04)
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