334819850-12-4-2024-10-CC-BMOS-DBMSUR-20241204131135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334819850
Report Date: 12/04/2024
Date Signed: 12/04/2024 01:13:14 PM

Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	DOPLITO FAMILY CHILD CARE		FACILITY NUMBER:	334819850
ADMINISTRATOR/ DIRECTOR:	DOPLITO, DOMITILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 445-7502
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	12/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Licensee, Domitila Doplito		TIME VISIT/ INSPECTION COMPLETED:	01:32 PM

NARRATIVE

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On December 4, 2024, 9:10 am, Licensing Program Analyst (LPA) Brian Morris arrived at the facility to conduct an annual inspection as part of a compliance review. LPA met with licensee Domitila Doplito. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday through Friday 5 am to 8 pm

· Off-limit areas include: Entire second story, laundry room, and garage

· There were 3 children present at the time of inspection and 1 staff.

· A working telephone is present and the current number is on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection.

· Fireplace is properly screened to prevent access by children

· All hazardous items are stored inaccessible to children

· Toxins are locked

· Weapons are not present as stated by licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs are barricaded

· Clean, safe and age appropriate toys

· Current roster on file

· Facility Sketch is posted. Emergency Disaster Plan and Notification of Parent’s Rights poster were not posted.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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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Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Prior to the Department issuing a license the applicant and all adults residing in the home shall obtain a California Criminal Record Clearance or Exemption. This requirement is not met as evidenced by: Based on observations, record review and interviews the licensee did not comply with sections sited above in 1 out of 5 adults in the home. Where adult #1 was not fingerprint cleared and was left alone supervising three children which poses a immidiate health, safety or risk to children in care.
	Deficient Practice Statement
1 2 3 4	Based on observation, interviewand record review, the licensee did not comply with the section cited above in 1 out of 9 persons which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/05/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy of Staff Ref #2 when the background is completed for the staff. The staff has an appointment set for 12/05/2024 at 11:00 AM.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy a of competed Fire Drill by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy a of competed Disaster Earthquake Drill by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy of Mandated Reporters certificate of completion by POC date.

Section Cited

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy of LIC 9227 Sleep plan for the infant children in care by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/04/2024 01:13 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy of LIC 9227 Sleep plan for the infant children in care by POC date.

Section Cited

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	The licensee will provide via email a copy of LIC 9227 15 minute checks/Sleep plan for the infant children in care by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carlos Martinez	TELEPHONE: (951) 805-5739
Brian Morris	TELEPHONE: 951-218-7031
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
	VISIT DATE: 12/04/2024

NARRATIVE

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· Documentation of fire and disaster drills are not on file. Licensee stated she has not conducted disaster drills. Deficiencies will be issued.

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Verification of control of property on file

· LPA reviewed four children’s files. Two children Ref #1 and Ref #2 were missing documentation of 15-minute sleep checks and sleep plans. Citations will be issued.

· Licensee reports, hiring an assistant whos first day at the facility was today 12/04/2024. The assistant is Georgina Escamilla. When this LPA arrived at the facility, Georgina Escamilla (Ref #2) was supervising the 3 children in the facility. Georgina does not have a background clearance, immunizations, Mandated reporter or 1^st Aid/CPR currently. Licensee states she was aware that Georgina did not have a background clearance and should not have been left alone with the children while the licensee dropped off children at school.

· Licensee’s Mandated Reporter Training is expired. Citations will be issued.

· Licensees 1^st Aid/CPR expires 8/2025.

· Licensee completed Health & Safety

· Resident and/or staff records were reviewed and all adults who require caregiver background checks have NOT received all required clearances and/or exemptions.

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian Morris	TELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
	VISIT DATE: 12/04/2024

NARRATIVE

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The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The facility is being cited for Health & Safety Code and Title 22 Regulations. See LIC809-D for cited deficiencies.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian Morris	TELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 8 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOPLITO FAMILY CHILD CARE	FACILITY NUMBER: 334819850
	VISIT DATE: 12/04/2024

NARRATIVE

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“Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee [facility representative].”

An exit interview was conducted, and this report was reviewed with the licensee Domitila Doplito. Appeal rights were discussed and provided during the exit interview. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian Morris	TELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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