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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820885
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:43:50 PM


Document Has Been Signed on 12/06/2023 03:43 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
334820885
ADMINISTRATOR:RODRIGUEZ, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 732-0565
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:14CENSUS: 6DATE:
12/06/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Blanca RodriguezTIME COMPLETED:
03:50 PM
NARRATIVE
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On December 6, 2023 at 1:28 pm, Licensing Program Analyst (LPA) Jessica Rubio arrived at the facility to conduct an annual inspection as part of a compliance review. LPA met with Licensee Blanca Rodriguez, 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 7:30 am to 6pm.

· Off-limit areas include: Entire second story and garage.

· The facility is licensed to have no more than 14 children as a large family child care home and is operating within the licensed capacity and appropriate ratios. LPA observed seven children in care with Licensee and an assistant providing care.


· Appropriate supervision was being provided during this inspection

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

· A fully charged fire extinguisher was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.

· Fireplace is properly screened to prevent access by children

· All hazardous items are stored inaccessible to children

· Weapons are not present on this date as stated by Licensee Blanca Rodriguez. 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 are provided

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


Document Has Been Signed on 12/06/2023 03:43 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above as two children (Ref#3 and 4) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2024
Plan of Correction
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2
3
4
Licensee stated she will get the immunizations on file and provide proof to LPA.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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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: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7


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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820885
VISIT DATE: 12/06/2023
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· Current roster on file

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· Documentation of fire and disaster drills are on file – Last drill was conducted on 11/30/2023

· No bodies of water are present 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 is on file.

· LPA reviewed six children’s files. Two children (Ref#3 and 4)were missing documentation of immunizations. A citation will be issued. Four children (Ref#1, 2, 5 and 6) were also missing LIC 282 forms. Three children (Ref#3 & 4 and 5) had sleep logs, however checks were not being documented every 15-minutes. Techincal violations will be issued. LPA provided technical assistance to Licensee.

· Employee’s records are complete

· Licensee’s Mandated Reporter Training expires on 11/27/2025

· Licensee's Pediatric CPR and First Aid Card expires on 10/2024

· Licensee’s Health & Safety Certificate - completed on 8/23/2008. Lead - 11/19/2020


· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send them email inquiries 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.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820885
VISIT DATE: 12/06/2023
NARRATIVE
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Licensee was reminded that all adults 18 and over, living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. Additionally, there is a link to “Receive Important Updates” located on the right side of the page, immediately above Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820885
VISIT DATE: 12/06/2023
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The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200

The facility is being cited for Title 22 Regulations. See LIC809-D for cited deficiencies.

During the exit interview, the Licensee Blanca Rodriguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
An exit interview was conducted, and this report was reviewed with the licensee Blanca Rodriguez. 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: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7