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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313965
Report Date: 11/02/2023
Date Signed: 11/02/2023 01:02:18 PM

Document Has Been Signed on 11/02/2023 01:02 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:SOTO DELGADILLO, MARIBELFACILITY NUMBER:
304313965
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
11/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Maribel Soto Delgadillo TIME COMPLETED:
01:10 PM
NARRATIVE
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On 11/2/23, Licensing Program Analyst (LPA) Patricia Duron conducted a Case Management due to deficiencies investigated through observation and review. LPA met with Licensee, Maribel Soto Delgadillo. Census was taken and observed 1 preschool child and 2 infants with licensee were in care.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the investigation, LPA observed and reviewed assistant's file. Staff 1(S1) was unable to provide proof of immunization against measles, pertussis and proof of immunization against influenza. Licensee’s assistant was unable to provide proof of mandated reporter training and proof of pediatric CPR and pediatric first aid. The facility is being cited for violating California Code of Regulations, Title 22, Division 12, Chapter 1 Section 1597.622(a)(1), 1596.8662(b)(1), and 102416(c)(1)(b). Please refer to attached 9099D for documentation of deficiencies.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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 11/02/2023 01:02 PM - It Cannot Be Edited


Created By: Patricia Duron On 11/02/2023 at 11:56 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: SOTO DELGADILLO, MARIBEL
FACILITY NUMBER: 304313965

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
Section Cited
HSC
1597.622(a)(1)

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1597.622(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee,volunteer...between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
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Licensee stated she will submit assistant's proof of immunizations records for assistant by 12/4/23.
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Based on observation and review the licensee's assistant was unable to provide proof of immunization against measles and pertussis. This poses a potential health and safety risk to children in care.
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Type B
12/04/2023
Section Cited
HSC1596.8662(b)(1)

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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 .... shall complete the mandated reporter training ... renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Licensee stated she will submit assistant's completed the mandated reporter training certificate to LPA by 12/4/23.
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Based on observation and review, proof of completion of required mandated reporter training was not available for review during today's inspection. This poses a potential health and safety risk to 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:Thuy Ho
LICENSING EVALUATOR NAME:Patricia Duron
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/02/2023 01:02 PM - It Cannot Be Edited


Created By: Patricia Duron On 11/02/2023 at 12:24 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: SOTO DELGADILLO, MARIBEL
FACILITY NUMBER: 304313965

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
Section Cited
CCR
102416(c)(1)(b)

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(c) The licensee and other personnel as specified shall complete training... including pediatric cardiopulmonary resuscitation and pediatric first aid,..(b)...a licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility...
This requirement is not met as evidenced by:
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The licensee will submit assitant's copy pediatric CPR/first aid training certificate by due 12/4/23.
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Based on observation and review, The licensee's assistant (staff1) did not have a copy of proof pediatric CPR/first aid. This poses a potential health and safety rish to 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:Thuy Ho
LICENSING EVALUATOR NAME:Patricia Duron
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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