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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310078
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:39:02 PM

Document Has Been Signed on 05/23/2023 02:39 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ROJAS, MARILUFACILITY NUMBER:
304310078
ADMINISTRATOR:ROJAS, MARILUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 306-4470
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marily Rojas - LicenseeTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Carmen Odom conducted an unannounced case management inspection regarding a self-reported unusual incident that was reported to the department on 05/18/23. Upon arrival LPA Odom met with Marilu Rojas. At 10:30am, LPA Odom observed a total of 9 children, which consist of 2 infants, and 7 preschool age children with 2 assistants caring for the children in childcare bedroom and childcare living room. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 05/18/23 the facility self-reported that on 05/17/2023 at 12:00pm Child #1 (C1) arrived at the childcare during lunch time. Staff #1 (S1) served C1 a bowl of soup, S1 turned around and was preparing the infant’s food when C1 had dropped their bowl of soup and landed on their right-side thigh. S1 observed that the soup left a red mark, S1 immediately put water on the red mark and Neosporin ointment on the red area. S1 called parents and parents picked up child.

During the investigation, LPA reviewed incident report, children’s roster, took pictures, obtained picture, reviewed text messages, interviewed 3 staff members, 3 children, and 1 parent. S1 stated on 5/17/23 during lunch time C1 dropped their bowl of soup on themselves, S1 did not see when C1 dropped the bowl on themselves because S1 was serving the infant’s meal. S1 realized C1 had dropped their bowl of soup on themselves when C1 cried. S1 immediately turned around and assisted C1 by comforting child, sitting the child on the couch, removing child’s clothes, placing wet pads on the red marks located on the right-side stomach and right-side thigh, and finally placing Neosporin ointment. After caring for C1’s injury S1 contacted both parents and sent picture of the injury to parents. On 5/23/23 LPA interviewed Parent #1 (P1), P1 disclosed S1 immediately informed P1 regarding C1’s injury. P1 disclosed they did not take C1 to the doctor because C1 was not in pain during pick up and the rest of the day C1 was fine.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ROJAS, MARILU
FACILITY NUMBER: 304310078
VISIT DATE: 05/23/2023
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P1 stated the red mark were gone by the following day and C1 returned the childcare facility. On 5/23/23 LPA interviewed 3 children that were present during the incident. C1 stated they dropped the bowl of soup because they don’t like soup. C1 disclosed S1 made them feel better by changing their clothes. Child #2 (C2) disclosed observing C1 playing with their soup and dropped their bowl of soup on themselves. Assistants disclosed that they did not witness the incident but S1 is always supervising the children in care.

The information obtained collaborated with the information reported by the Licensee. Statements made by witnesses indicate that the incident was an accident and S1 was present during the incident. Reporting requirement were met. Based on LPA observations, interviews conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview conducted with Licensee Marilu Rojas. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of the report (LIC 809). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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