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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844254
Report Date: 09/06/2019
Date Signed: 09/06/2019 11:30:28 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:RODRIGUEZ DE ESTRADA FAMILY CHILD CAREFACILITY NUMBER:
334844254
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
09/06/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cruz Rodriguez de EstradaTIME COMPLETED:
11:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Blanca Ruiz-Silva and Samuel Lopez arrived at the facility to conduct a Case Management inspection as a result of information disclosed during an investigation of complaint 09-CC-20190726170239 on 8/1/19. This inspection was conducted in Spanish. During that investigation visit it was learned that Child#1 was injured at the facility, while using a play structure that was not age appropriate for the injured child. The Licensee failed to report the incident to Community Care Licensing in a timely manner.

The following deficiencies were cited:

102416.2(b) Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS.

Appeals rights were discussed and a copy of this report was provided to the licensee on this date. The report must be made available to the public, upon request, for the next 3 years.

****This report is being amended to reflect the correct time of completion which is 11:20am and not 11:20pm****
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
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: RODRIGUEZ DE ESTRADA FAMILY CHILD CARE
FACILITY NUMBER: 334844254
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2019
Section Cited

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102416.2(b)Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement was not met as evidenced:
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Licensee failed to report a child being inured while using play equiment that was not adequate for the child's age. The incident was not reported to licensing within the required time limit of 24 hours via phone and seven days in writing. This poses a potential risk to the Health and safety of 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: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2019
LIC809 (FAS) - (06/04)
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