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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314238
Report Date: 02/03/2025
Date Signed: 02/05/2025 05:12:59 PM

Document Has Been Signed on 02/05/2025 05:12 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:RODRIGUEZ, ERIKENDY & MARTIN, SEANFACILITY NUMBER:
304314238
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, E. & MARTIN, S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 979-0252
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/03/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:10 PM
MET WITH:Licensee, Erikendy RodriguezTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
NARRATIVE
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On 2/3/2025, Licensing Program Analyst (LPA) Sun conducted a Case Management – Deficiencies due to deficiencies observed during a visit. LPA informed licensee Erikendy Rodriguez of the purpose of the Case Management.

Upon arrive at 12:10pm, LPA met with licensee Erikendy Rodriguez and toured the facility. LPA observed licensee alone caring for 4 infants (ages 0-24 months old) and 4 preschoolers (ages 2 to 3 years old). Children were sleeping in their cribs/playpens. Licensee was operating facility out of ratio. LPA also observed 4 of 4 infants sleeping with loose articles (bottles and blankets) inside Cribs/play yards.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

During the staff file review, LPA observed staff #1 (S1) and staff 2 (S2)’s files were missing the Mandated Reporter Training Certificates. LPA also observed S1’s current Pediatric CPR & First Aid Certificate was not issued from neither American Red Cross nor American Heart Association and it was missing the Emergency Medical Services Authority (EMSA) approved sticker.

The facility was not in compliance. The following deficiency was observed and cited today per CA Code of Regulations, Title 22, Division 12 (See LIC 809D for specific deficiency).

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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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: RODRIGUEZ, ERIKENDY & MARTIN, SEAN
FACILITY NUMBER: 304314238
VISIT DATE: 02/03/2025
NARRATIVE
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Exit interview conducted and report was reviewed with the licensee. Appeal Rights were discussed. The facility representative was provided a copy of their 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. A notice of site visit was provided and must remain posted for 30 days.

Licensee Erikendy Rodriguez was informed that this licensing report dated 2/3/2025 documents two “Type A” citations. Type A citation reports 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 Sun further informed the licensee that 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, 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, and 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.








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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 02/05/2025 05:13 PM - It Cannot Be Edited


Created By: Cynthia Sun On 02/03/2025 at 06:48 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: RODRIGUEZ, ERIKENDY & MARTIN, SEAN
FACILITY NUMBER: 304314238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2025
Section Cited
CCR
102425(b)

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102425(b) Infant Safe Sleep: Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidence:
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Licensee stated as of today 2/3/25 they will keep the cribs/playpen empty of loose objects.
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Based on LPA observation. Upon arrival at 12:10pm, LPA observed 4 of 4 infants sleeping with loose articles (bottles and blankets) inside Cribs/play yards. This poses an immediate risk to the safety 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:Thuy Ho
LICENSING EVALUATOR NAME:Cynthia Sun
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/05/2025 05:13 PM - It Cannot Be Edited


Created By: Cynthia Sun On 02/03/2025 at 06:57 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: RODRIGUEZ, ERIKENDY & MARTIN, SEAN
FACILITY NUMBER: 304314238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
HSC
1024(c)(1)(d1)

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102416(c)(1)(d1) Personnel Requirements: A current pediatric cardiopulmonary resuscitation card issued either by the American Red Cross or the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191. This requirement is not met as evidence:
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Licensee stated she will have surgery this month. Licensee asked for 2/21/25 as deadline for completion of required CPR/First Aid.
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Pediatric CPR & First Aid Certificate was not issued from neither American Red Cross nor American Heart Association and it was missing the Emergency Medical Services Authority (EMSA) approved sticker. This poses a potential risk to the safety 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:Thuy Ho
LICENSING EVALUATOR NAME:Cynthia Sun
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 02/05/2025 05:13 PM - It Cannot Be Edited


Created By: Cynthia Sun On 02/03/2025 at 07:09 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: RODRIGUEZ, ERIKENDY & MARTIN, SEAN
FACILITY NUMBER: 304314238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
HSC
1956.8662

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H&S 1956.8662: 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), paragraphs (2) and
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Licensee stated she will have surgery this month. Licensee asked for 2/21/25 as deadline for completion of required Mandated Reporter Training.
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(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. This requirement is not met as evidence: Based on record review. S1 and S2 were missing the Mandated Reporter Training Certificates. This poses a potential health and safety risk to 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:Thuy Ho
LICENSING EVALUATOR NAME:Cynthia Sun
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 02/05/2025 05:13 PM - It Cannot Be Edited


Created By: Cynthia Sun On 02/03/2025 at 07:30 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: RODRIGUEZ, ERIKENDY & MARTIN, SEAN
FACILITY NUMBER: 304314238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2025
Section Cited
HSC
102416.5(b)(2)

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102416.5 (b)(2) Staffing Ratio and Capacity: For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
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Licensee stated she will talk with spouse to have him start working with licensee at facility as of tomorrow 2/3/25. Licensee stated she has 4 infants currently in facilty. Licensee will drop one infant from facility enrollment.
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Six children, no more than three of whom may be infants. This requirement is not met as evidence: Based on LPA observation. Upon arrival at 12:10pm, LPA observed licensee was alone caring for 4 infants ages 0-24 months old and 4 children ages 2-3 years old. This poses an immediate risk to the safety 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:Thuy Ho
LICENSING EVALUATOR NAME:Cynthia Sun
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


LIC809 (FAS) - (06/04)
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