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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312411
Report Date: 05/25/2021
Date Signed: 05/25/2021 03:35:28 PM

Document Has Been Signed on 05/25/2021 03:35 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: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: 0CENSUS: DATE:
05/25/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee Martha A Jauregui TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Barajas conducted a Case Management Investigation. LPA met with Licensee, Martha Jauregui, who guided LPA on tour of the facility. Licensee had 6 preschool children in care during today's visit with assistant Alma Garcia. . A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 04/14/21 upon arrival LPA met with Gustavo Jauregui, who granted LPA entrance to the facility. Licensee Martha Jauregui was on her way out but decided to stay for visit. Licensee walked LPA to day care area. LPA Barajas observed in day care room a child sitting in a highchair at 11:23am. LPA did not observe food or water or child eating or drinking. LPA touched white highchair and appeared to be dry. LPA did not observe any other children eating or drinking water but playing with toys in the area. LPA Barajas took a picture of child inside the highchair. LPA observe children having lunch at 12pm.

On same day 04/14/21, LPA asked assistant Alma what child was doing in highchair and assistant stated child was drinking water. LPA did not observe any water cup on top of chair. Licensee started saying out loud in Spanish to assistant “I told you not to use the highchairs”. LPA requested staff to remove child from highchair immediately.

Based on visual observation and picture taken on 04/14/21 at 11:23am a child was being restrained on white highchair, not strapped, child was not observed drinking or eating while sitting on high chair. This is a potential hazard to children. A highchair is manufactured for a child to sit while eating. Therefore, it has been determined that children’s personal rights have been violated. Facility will be cited Personal Rights 102423(a)(2) on attached LIC 809D.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: JAUREGUI, MARTHA ALICIA & GUSTAVO
FACILITY NUMBER: 304312411
VISIT DATE: 05/25/2021
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Personal Rights 102423(a)(2): (a)Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

Exit interview was conducted with Licensee Martha Jauregui via Tele-Inspection. Report was read to Licensee. A copy of the report along with Appeal Rights will be emailed to Licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 809 will also be mailed if those options are not available.

End of Report.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/25/2021 03:35 PM - It Cannot Be Edited


Created By: Leonor Barajas On 05/25/2021 at 01:00 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: 05/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/26/2021
Section Cited
CCR
102423(a)(2)

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102423(a)(2) Personal Rights Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
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Licensee stated has removed white high chairs, cut them, and trained all staff in regards to high chair use during eating time only. Licensee stated will email LPA plan of correction due by 05/26/21.
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LPA Barajas based on visual observation and picture taken on 04/14/21 at 11:23am a child was being restrained on white highchair, not strapped, child was not observed drinking or eating while sitting. This is an immediate risk to the personal rights 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:Patricia Magana
LICENSING EVALUATOR NAME:Leonor Barajas
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2021


LIC809 (FAS) - (06/04)
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