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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630196
Report Date: 03/25/2026
Date Signed: 03/25/2026 11:52:33 AM

Document Has Been Signed on 03/25/2026 11:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BELONY DORVILUS, VENITA FAMILY CHILD CAREFACILITY NUMBER:
376630196
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
03/25/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Venita Belony DorvilusTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 03/25/2026, at 8:30 am, Licensing Program Analyst (LPA), Danielle Anderson conducted an unannounced case management inspection with the licensee, Venita Belony Dorvilus. LPA notified the licensee the purpose of the inspection was for a change of capacity regarding and the licensee led LPA on a tour of the facility. There (2) children in the facility during the time of the inspection, one of which was a minor resident in the home. Interpretation into Haitian Creole was provided by interpreter #98475900 and 98477161. Licensee stated the facility operates Monday through Sunday twenty four hours a day. The licensee is reminded that care can not be provided for any one child for more than 23 hours at a time.

On 03/11/26, a fire clearance was approved for 14 children by the SDFD. Licensee will use the following areas for childcare: living room, daycare room, kitchen (safety gate), bathroom, and back patio. The off-limits area is made inaccessible via safety gates and doorknob covers. There are no bodies of water observed during the time of inspection. There are enough age-appropriate toys, games, and books available. The home was clean and orderly during the inspection. The fire extinguisher is rated 2-A;10; BC, smoke alarm, and carbon monoxide detector are operational. The is a working telephone in the home and all required forms are posted. The licensee stated that there are no firearms or ammunition on the property. Licensee stated they do provide transportation to children. Licensee is reminded to follow all seat belt and car seat laws while transporting children. The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Any minor upon his/her 18th birthday must be fingerprinted within 30 days. LPA reviewed children's files. The licensee provided LPA a copy of the facility roster. The last fire/disaster drill was conducted 04/15/2025. Pediatric CPR and First Aid certification expired 2/2026. There was no helper file available for review. LPA reviewed the following with the licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, and care and supervision. Licensee was also reminded the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare. LPA provided and copy of LIC126 and it was reviewed with the licensee.
NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Danielle Anderson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2026
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 5
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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Document Has Been Signed on 03/25/2026 11:52 AM - It Cannot Be Edited


Created By: Danielle Anderson On 03/25/2026 at 10:13 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BELONY DORVILUS, VENITA FAMILY CHILD CARE
FACILITY NUMBER: 376630196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2026
Section Cited
CCR
102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
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The licensee shall set an appointment to obtain pediatric CPR and send proof to the department by 3/30/2026.
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 individuals who are alone caring for children without valid CPR card which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
03/30/2026
Section Cited
CCR102421(b)

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(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
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The licensee shall submit proof of fully completed LIC 700 and all other required licensing forms for all children enrolled at the facility to the department for review by 3/30/2026.
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Based on interview and record review, the licensee did not comply with the section cited above in 8 out of 8 children enrolled to the facility did not have emergency information card which 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.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Danielle Anderson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/25/2026 11:52 AM - It Cannot Be Edited


Created By: Danielle Anderson On 03/25/2026 at 10:25 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BELONY DORVILUS, VENITA FAMILY CHILD CARE
FACILITY NUMBER: 376630196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2026
Section Cited
CCR
102425(j)(D)

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(D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

a. Date.
b. Infant’s name.
c. Time of each 15-minute check.

This requirement is not met as evidenced by:
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The licensee shall submit proof of completed sleep log for the infant enrolled to the facility to the department by 4/2/2026.
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 infants in care not having a documented sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
04/03/2026
Section Cited
CCR102418(g)

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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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The licensee shall ensure that all children's files include immunizations or proof of school enrollment by 4/3/2026 and submit proof to the department.
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 children not enrolled in school by not having immunization records which 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.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Danielle Anderson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2026


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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BELONY DORVILUS, VENITA FAMILY CHILD CARE
FACILITY NUMBER: 376630196
VISIT DATE: 03/25/2026
NARRATIVE
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Licensee did not have documented safe sleep log for the infant that is currently enrolled. LPA discussed Safe sleep with the licensee. LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. The applicant understands they must physically check on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] will be maintained for each infant up to 12 months of age and shall be available to the Department for review. The licensee understands infants up to 12 months of age must be placed on their backs for sleeping. LPA also informed the applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

The maximum capacity for a large family childcare home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there are no Qualified Assistants, 14 years of age or present, the capacity reverts to the requirements for a Small Family Child Care.

To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov. . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

There were 4 Type B deficiencies cited at the time of inspection, See LIC809D pages.

An exit interview was conducted with licensee Venita Belony Dorvilus. A copy of the licensing report and appeal rights were provided to the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Licensee shall provide proof of negative TB test for two adult residents, provide signed LIC 9149, and
clear all Plans of Corrections (POCs) associated to this inspection before a change of capacity shall be granted.

A Regular Large Family Child Care Home license may be issued for 14 children upon final file review.
NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Danielle Anderson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC809 (FAS) - (06/04)
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