<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002901
Report Date: 07/15/2024
Date Signed: 07/15/2024 12:01:51 PM

Document Has Been Signed on 07/15/2024 12:01 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NIOBE HOMEFACILITY NUMBER:
306002901
ADMINISTRATOR/
DIRECTOR:		LAURA L. RUBIOFACILITY TYPE:
735
ADDRESS:2166 W. NIOBE AVENUETELEPHONE:
(714) 502-0710
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 3DATE:
07/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Laura Rubio, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct a Case Management-Deficiency visit. LPA was greeted and granted entry by Policarpo Veliz , House Manager. During today’s visit, LPA met with Laura Rubio, Administrator (AD).

The purpose of today's visit is to amend the civil penalty form from the annual required visit on July 1, 2024 and follow-up with Administrator regarding the status of her certificate. LPA contacted the Administrator Certification Bureau (ACB) and spoke with Amar Singh, ACB Office Technician who explained that AD's license lapsed from December 23, 2022 through April 30, 2024 when she submitted her paperwork for renewal. Amar explained that the AD was within her four year grace period for renewal and submitted her application and paid all current and delinquent fees. The application is in the four-month pending batch for review.

LPA shared this information with AD Rubio and explained that the civil penalty assessed on July 1, 2024 was incorrect and that it would be amended to a $250 one-time civil penalty for the administrator certficate license lapse period of December 23, 2022 through April 30, 2024. LPA also recommended that AD continue an additional forty hours of training and to pay her renewal fee for her license to be re-submitted in December 2024 so that she will be current.

An exit interview was conducted with Laura Rubio, Administrator and a copy of this report was given to the facility along with a copy of the LIC 421-FC.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1