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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312411
Report Date: 08/03/2023
Date Signed: 08/03/2023 04:56:55 PM

Document Has Been Signed on 08/03/2023 04:56 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
ORANGE CO CHILD CARE, 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: 14CENSUS: 16DATE:
08/03/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Martha JaureguiTIME COMPLETED:
05:15 PM
NARRATIVE
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On August 3 of 2023 at approximately 1:40 PM, LPAs A. Silva and V. Trinh conducted a POC visit to follow up on the plans of correction issued on 8/2/23. The LPAs entered the facility from the alley, through the back door.
Upon arrival the licensee had 16 children in care. LPA Silva interviewed the licensee. The licensee stated that her assistants took in more children while licensee was taking a break.

Based on observations and interviews with the licensee, the LPA determined the facility was in violation of fire clearance capacity and license capacity. The facility has fire clearance for a total of 14 children. The facility is licensed for a maximum capacity of 14 children. According to Title 22, Division 12, Chapter 1, Section 102416.5(f) Staffing Ratio and Capacity, “(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.” There were 16 children at the day care. A civil penalty was assessed.

The LPA reviewed the staff files. Based on records review and interview with the licensee, S4 did not have a current mandated reporter in file. The mandated reporter in file for S4 expired on 6/8/23. According to HSC 1596.8662(b)(1), On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the HSC and California Code of Regulations, Title 22; Division 12, were observed and cited today: 102416.5(f) Staffing Ratio and Capacity and 1596.8662 Administration of Child Day Care Licensing.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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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Document Has Been Signed on 08/03/2023 04:56 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 08/03/2023 at 04:00 PM
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: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2023
Section Cited
CCR
102416.5(f)

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102416.5(f) Staffing Ratio and Capacity The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.”
The licensee did not comply with this requirement as evidenced by:
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The licensee stated she has six clients for whom she is a secondary provider, provides care in a as need bases. Licensee stated she will stop serving as secondary provider to those children.
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Based on observation and interview with licensee, licensee did not comply with the requirement in 2 out of 2 clients, which poses an immediate risk to the health and safety of clients. 16 clients were in attendance which violates license capacity and fire clearance. One infant included.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023


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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411
VISIT DATE: 08/03/2023
NARRATIVE
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LPA A. Silva informed licensee Martha Jauregui that this licensing report dated 8/3/2023 documents 1 “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensee Martha Jauregui that:
  1. A copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care.
  2. A copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report.
  3. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the child's file for verification of receipt of the report.

The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was posted and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), 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.

END.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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