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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314128
Report Date: 07/09/2025
Date Signed: 07/09/2025 03:48:59 PM

Document Has Been Signed on 07/09/2025 03:48 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:DUBEY, MARIAFACILITY NUMBER:
304314128
ADMINISTRATOR/
DIRECTOR:		DUBEY, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 906-4622
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/09/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Licensee Maria DubeyTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Giselle Lucero conducted an unannounced case management inspection to ensure the in-ground swimming pool located at the facility meets the new requirements for the new pool safety regulations that went effective as of 01/01/2025. LPA observed licensee and 2 assistants caring for 11 children, which included 2 infants, 5 preschool and 4 school age children.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA and Licensee entered the area and inspected the in-ground pool. LPA observed the in-ground swimming pool did not meet the new pool safety regulations. LPA observed the following:

1. Pool fence did not meet the requirement of a maximum vertical clearance of 2 inches from the ground to the bottom of the fence. LPA observed it was approximately greater than 3 inches from the ground to the bottom of the fence; (see LIC 809D for deficiency).

2. LPA observed a bedroom window from an off-limit room that has access to the backyard did not have iron bars installed on the bedroom window nor a gate installed between the gap of the house and the brick wall to ensure inaccessibility to the pool; (see LIC 809D for deficiency).

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NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: DUBEY, MARIA
FACILITY NUMBER: 304314128
VISIT DATE: 07/09/2025
NARRATIVE
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3. An access gate that is self closing with self latching; LPA opened gate and gate either slowly closed or did not close completely. LPA advised applicant to reinforce door spring to ensure self closing. A technical advisory is being issued.

4. LPA observed pool did not have either a pool cover installed or the correct pool alarm; (see LIC 809D for deficiency).

5. LPA observed there was no rescue pole with a body hook with a minimum fixed length of 12 feet available; (see LIC 809D for deficiency).

6. LPA observed there was no daily inspection log completed; (see LIC 809D for deficiency).

LPA provided Licensee with Assembly Bill (AB) 2866 and Provider Information Notice (PIN) 25-01 for new pool safety regulations.

There for in the areas that were evaluated, 5 Type B deficiencies were observed. The facility was not in compliance and violations of the California Code of Regulations (CCR), Title 22, Division 12 and Health and Safety Code (HSC) were observed, discussed, and cited at the time of the visit. The following violations of HSC, were observed: Pool Safety 1596.814(a)(1)(A), Pool Safety 1596.814(a)(1)(A)(iii), Pool Safety 1596.814(a)(1)(B), Pool Safety 1596.814(a)(2)(B) and Pool Safety 1596.814(a)(3); (see LIC 809D).

Exit interview conducted and report was reviewed with the licensee Maria Dubey. A notice of site visit was posted and must remain posted for 30 days.



End of Report.
NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 07/09/2025 03:48 PM - It Cannot Be Edited


Created By: Giselle Lucero On 07/09/2025 at 02:01 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: DUBEY, MARIA
FACILITY NUMBER: 304314128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2025
Section Cited
HSC
1596.814(a)(1)(A)

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Pool Safety 1596.814(a) A licensed family daycare home..with an in-ground swimming pool..shall comply with all of the following requirements: (1) The swimming pool shall be equipped with...(A)... a fence.. has all of the following characteristics: (iii) A maximum vertical clearance of two inches from the ..
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Licensee stated she will make alterations to the fence to ensure there is a vertical clearance of two inches from the ground to the bottom of the fence and will provide proof to LPA by POC due date.
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ground to the bottom of the enclosure. This requirement is not met based on observation, the pool fence was greater then 3 inches from the ground to the bottom of the fence. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/23/2025
Section Cited
HSC1596.814(a)(1)(B)

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Pool Safety 1596.814(a) A licensed family daycare home..with an in-ground swimming pool..shall comply with all of the following requirements: (1) The swimming pool shall be equipped with...(B) In addition to the characteristics described in subparagraph (A), at least one of the following...
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Licensee stated she will purchase the correct pool alaram and will provide proof to LPA by POC due date.
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This requirement is not met based on observation, pool did not have a pool cover installed or the correct pool alarm purchased. This poses/posed a potential health, safety or personal rights risk to persons 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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Giselle Lucero
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2025 03:48 PM - It Cannot Be Edited


Created By: Giselle Lucero On 07/09/2025 at 02:20 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: DUBEY, MARIA
FACILITY NUMBER: 304314128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2025
Section Cited
HSC
1596.814(a)(2)(B)

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Pool Safety 1596.814 (a) A licensed family daycare home..with an in-ground swimming pool..shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible.. (B) A rescue pole with a body hook and a minimum fixed length of 12 feet. This requirement is..
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Licensee stated she will purchase correct rescue pole by POC due date.
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not met as evidenced by: Based on observation, pool did not have a rescue pole with a minimum fixed length of 12 feet. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/23/2025
Section Cited
HSC1596.814(a)(3)

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Pool Safety 1596.814 (a) A licensed family daycare home..with an in-ground swimming pool..shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the...
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Licensee stated once safety features and safety equipment are purchased and installed, she will keep a daily daily inspection document.
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inspections to be provided to the department upon request. This requirement is not met as evidenced by: Based on observation, Licensee did not have a daily inspection log. This poses/posed a potential health, safety or personal rights risk to persons 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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Giselle Lucero
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2025 03:48 PM - It Cannot Be Edited


Created By: Giselle Lucero On 07/09/2025 at 02:56 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: DUBEY, MARIA
FACILITY NUMBER: 304314128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2025
Section Cited
HSC
1596.814(a)(1)(A)

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Pool Safety 1596.814(a) A licensed family daycare home..with an in-ground swimming pool..shall comply with all of the following requirements: (1) The swimming pool shall be equipped...(A) An enclosure.. a fence, wall, or other barrier that isolates the swimming pool from access to the family...
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Licensee stated she will install safety precautions to ensure bedroom window has inaccessibility to backyard.
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daycare home. This requirement is not met as evidenced by: Based on observation a window from an off-limit room did not have iron bars nor a gate installed to ensure inaccessibility to the pool. This poses a potential health, safety or personal rights risk to persons 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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Giselle Lucero
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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