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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312411
Report Date: 05/11/2023
Date Signed: 05/11/2023 10:48:34 AM

Document Has Been Signed on 05/11/2023 10:48 AM - 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:JAUREGUI, MARTHA ALICIA & GUSTAVOFACILITY NUMBER:
304312411
ADMINISTRATOR:JAUREGUI, G & MARTHA AFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 699-1023
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 24CENSUS: 2DATE:
05/11/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Martha and Gustavo Jauregui - licenseesTIME COMPLETED:
11:00 AM
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An inspection was conducted on this date by Licensing Program Analyst (LPAs) Odom and Silva for the purpose of reviewing and placing licensee on a Compliance Plan.

At 8:30am during today's inspection, upon arrival Licensee (Gustavo Jauregui) allowed LPAs entrance into the childcare facility. LPAs observed licensee caring for 1 preschool age child eating breakfast inside the childcare room located in the back of the home and Licensee (Martha Jauregui) was upstairs on the second floor. At 8:35am Assistant, Roopkiran Bhatti, arrived at the childcare facility. LPAs reviewed the fingerprint clearance list for assistant’s name and assistant was not associated to the facility. Assistant stated they have been working in the childcare facility for the last 5 months. Licensee stated they completed the live scan form on 9/21/2022. LPAs verified Guardian system and the records show that the application was incomplete. Licensee dismissed assistant at 9:00am.

The licensee stated there are currently 4 adults living in the home. During today’s inspection the home and grounds were toured, and the licensees were operating within the licensed capacity.

During today’s inspection, LPAs and licensee (Martha Jauregui) toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of baby gates, and baby doorknobs. The childcare area consists of the back room with built in kitchen, bathroom and storage room. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411
VISIT DATE: 05/11/2023
NARRATIVE
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The facility does not have a fireplace. The facility has central air conditioning in the childcare room. The home has age appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service). The backyard is used for outdoor play area, LPA inspected the outdoor gates to verify doors are locked and secure. There are no bodies of water on the premises. Children are dropped off from the back ally and come in through the backyard.

The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. Licensee stated, there are no infants under 24 months enrolled in the childcare facility at this time.

The licensees Pediatric CPR/First Aid certification expired 5/2025. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensees and assistant were reviewed and within compliance.
Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

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

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.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
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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: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411
VISIT DATE: 05/11/2023
NARRATIVE
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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.

The Department will monitor the licensee’s compliance with the Compliance Plan over the next two years to determine whether the licensee is operating the facility in a manner consistent with the law and the Compliance Plan. The licensee understands and acknowledges that the Department, at its discretion, will make unannounced case management visits to monitor the licensee’s compliance with this Compliance Plan.

Based on LPAs observations, record reviews and interviews the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 102370(d)(1) is being cited on the attached LIC 809D.

LPAs Odom and Silva informed licensee Martha Jauregui that this report dated 5/11/2023 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPAs Odom and Silva informed the licensee Martha Jauregui to provide a copy of this licensing report dated 5/11/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

Exit interview conducted and report was reviewed with the licensee Martha Jauregui. A notice of site visit was given and must remain posted for 30 days.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
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: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411
VISIT DATE: 05/11/2023
NARRATIVE
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Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/11/2023 10:48 AM - It Cannot Be Edited


Created By: Carmen Odom On 05/11/2023 at 10:12 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/11/2023
Section Cited
CCR
102370(d)(1)

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102370(d)(1) Criminal Record Clearance. (d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing...:(1) Obtain a California clearance or a criminal record exemption as req...
This requirement is not met as evidenced by:
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Licensee dismissed assistant at 9:00am, provided the live can form and told them to re-complete the live scan. Licensee understands assistant cannot return to the childcare facility until assistant's fingerprint clearance is cleared and associated to the facility. Licensee will submit a copy of the completed live scan form to licensing office.
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Based on observation and interviews licensee failed to ensure assistant, Roopkiran Bhatti, was fingerprint cleared and associated to the childcare facility prior employment. This poses an immediate risk to the health and safety of children in care.
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Licensee will submit a written statement with their plan of correction by 5/12/24.

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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:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023


LIC809 (FAS) - (06/04)
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