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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313965
Report Date: 12/05/2023
Date Signed: 01/03/2024 03:46:18 PM

Document Has Been Signed on 01/03/2024 03:46 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 COUNTY CC RO, 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: 5DATE:
12/05/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maribel Soto, LicenseeTIME COMPLETED:
01:45 PM
NARRATIVE
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*** This report was amended to correct the citation issued for deficiency observed during the visit. Deficiency observed on 12/05/23 is dismissed since plan of correction for the same deficiency, was previously cited on 12/04/2023, is due on 12/11/2023. ***

*** This Case Management was translated into Spanish by LPA Valdez Santana ***

This is a follow-up proof of correction case management inspection that was made by Licensing Program Analyst (LPA) Tran and LPA Valdez Santana. Observed at the time of the visit was a total of 4 children including 2 infants and 2 preschool children. Licensee was operating within compliance with ratio and capacity. LPAs informed the Licensee of the purpose of the visit.
A review of the Facility Personnel Report Summary on 12/04/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
During today's visit, a tour was conducted inside and outside of the facility, LPAs observed no baby saucer or baby rockers in the day care area. The backyard play area was inspected and is free from hazards. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible.

At 11:30am, LPAs observed Licensee was caring for Child #1 (C1), Child #2 (C2), Child #3 (C3), and Child #4 (C4). C1, C2, C3 were present during visit conducted on 12/04/2023. C4 was not present during the visit conducted on 12/04/2023. When interviewed, Licensee stated C4 was supposed to attend the daycare starting yesterday but C4 did not come due to not feeling well, so today, it is C4's first day attending the day care. When asked, Licensee did not have a file for C4. This is a repeat violation of a deficiency that was cited on 12/04/2023. At 12pm, Child #5 (C5) was dropped off at the facility. Licensee was able to provide a file for C5. (Continue next page)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SOTO DELGADILLO, MARIBEL
FACILITY NUMBER: 304313965
VISIT DATE: 12/05/2023
NARRATIVE
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*** This Case Management was amended to correct the citation issued for deficiency observed during today's visit. Deficiency observed today is dismissed since plan of correction for the same deficiency, was previously cited on 12/04/2023, is due on 12/11/2023. ***

(Page 2 of Report)

During today inspections, LPAs provided letter of deficiency cleared to Licensee for the deficiencies cited on 12/03/2023 regarding Staffing Ratio and Capacity 102416.5 (b) (2), Plan Of Operation 102417 (b), and 102417 (d) (1).

Based on LPAs' observations, record reviews and interviews, the following deficiency was observed in accordance to California Code and Regulations, Tittle 22, Division 12, 102417 (g) (7) Operation of a Family Child Care Home. No citation was cited today since plan of correction for the same deficiency, which was previously cited on 12/04/2023, is due on 12/11/2023.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maribel Soto.

(End of Report)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/03/2024 03:54 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/03/2024 10:22 AM


Created By: Nguyen K Tran On 12/05/2023 at 12:45 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SOTO DELGADILLO, MARIBEL
FACILITY NUMBER: 304313965

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2023
Section Cited
CCR
102417(g)(7)

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102417 Operation of a Family Child Care Home (g) ...Safety precautions shall include...: (7) An emergency information card shall be maintained for each child...
This requirement is not met evidenced by:
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*** Deficiency was dismissed on this date due to Plan of Correction for this deficiency which was previously cited on 12/04/2023, was due on 12/11/2023 ***
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Based on record review, Licensee did not have emergency card for Child #4, this posed a potential health, safety and personal rights risk for 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:Judy Hanson
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2023


LIC809 (FAS) - (06/04)
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