376628971-10-28-2021-20-CC-DSTS-C88UD7-20211028152904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628971
Report Date: 10/28/2021
Date Signed: 10/28/2021 03:29:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	DORVILUS, ROSE ERTHA FAMILY CHILD CARE		FACILITY NUMBER:	376628971
ADMINISTRATOR:	ROSE ERTHA DORVILUS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 394-9731
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	14	CENSUS: 7	DATE:	10/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Rose Ertha Dorvilus		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/28/2021, at 12:20 PM, Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Required Inspection and met with the Licensee, Rose Ertha Dorvilus. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven children ages 16 months, 19 months, 2 1/2, 3, 3, 3, and 6 and one child care assistant were also present during this inspection. 16 children are currently enrolled. This facility is a two- story, 6 bedroom, 4 bathroom house. Licensee accompanied LPA inside and outside the facility during this inspection. The following areas are used for child care: Living room, kitchen, daycare room and two bathrooms. Off-Limit areas are the laundry room, garage, and the entire upstairs. The laundry room and garage are made inaccessible with door locks. The stairs were not barricaded due to a broken safety gate. The home has a fenced section of the backyard area available for outdoor activities. There is an in-ground pool in the backyard that is made inaccessible to children by fencing as required by regulation. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys and play equipment and materials available. A baby rocker was present in the backyard play area. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 09/2023. Licensee has required immunization. Licensee completed Mandated Reporter Training 07/2020. Facility roster is maintained and was reviewed. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions Duty Line was provided: (619) 767-2248.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DORVILUS, ROSE ERTHA FAMILY CHILD CARE	FACILITY NUMBER: 376628971
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview, the licensee did not comply with the section cited above in 1 out of 1 instance by not barricading the stairs when children under 5 were present which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/29/2021
	Plan of Correction
1 2 3 4	Licensee will send photo of barricaded stairs to LPA vial email.

Type B

Section Cited

CCR

102417(g)(10)

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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview the licensee did not comply with the section cited above, there was a baby rocker present in the backyard play area which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/28/2021
	Plan of Correction
1 2 3 4	Licensee removed baby rocker from daycare area and placed in an off-limits area.

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: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DORVILUS, ROSE ERTHA FAMILY CHILD CARE	FACILITY NUMBER: 376628971
	VISIT DATE: 10/28/2021

NARRATIVE

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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.

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 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

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/inspection-process.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Exit interview was conducted and a copy of this report was provided to Licensee. Notice of Site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC809 (FAS) - (06/04)

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