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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416809
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:32:41 AM

Document Has Been Signed on 09/27/2023 11:32 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MORALES RODRIGUEZ, JESUSFACILITY NUMBER:
444416809
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Jesus Morales RodriguezTIME COMPLETED:
11:42 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Jesus Morales Rodriguez, to conduct case management visit. Upon arrival, LPA was admitted into the home by Estephania Torres and observed there were five children present (2 infants, 3 preschool-age). There was additionally one minor who lives in the home present today.

During today's inspection, LPA interviewed Jesus, reviewed children and staff files, and obtained copy of facility roster (LIC9040). LPA Nelson confirmed adults and minors who live in the home and reviewed reporting requirements with Jesus. LPA Nelson additionally reviewed Infant Safe Sleep requirements.

LPA advised Jesus that all individuals working/living in the day care home must obtain fingerprint clearances and be associated to the home prior to initial presence in the home. Estephania was not associated to Jesus's day care home and he states that she has been helping for the past few months already.

As a result of todays inspection, deficiencies were cited, see LIC809-D.

Exit interview conducted and report was reviewed with the Licensee, Jesus Morales Rodriguez.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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 3
Document Has Been Signed on 09/27/2023 11:32 AM - It Cannot Be Edited


Created By: Cortney Nelson On 09/27/2023 at 10:29 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MORALES RODRIGUEZ, JESUS
FACILITY NUMBER: 444416809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2023
Section Cited
CCR
102370(d)(1)

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101170 Criminal Record Clearance (d) All individuals subject to a criminal record review ...shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance

This requirement was not met as evidenced by:
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LPA obtained completed transfer request for Estephania to be associated to Jesus's FCCH.

-civil penalty assessed-
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The Licensee did not complete criminal record clearance transfer for Estephania Torres-Vasquez, which poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
09/29/2023
Section Cited
CCR102425(c)

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102425 Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

This requirement was not met as evidenced by:
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The Licensee will submit Individual Infant Sleep Plan (LIC9227) for all infants in care under 12 months of age by 9/29/2023.
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The Licensee did not complete the Individual Infant Sleep Plan (LIC9227) for two infants in care, which poses a potential threat to the health, safety, and personal rights of 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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/27/2023 11:32 AM - It Cannot Be Edited


Created By: Cortney Nelson On 09/27/2023 at 10:48 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MORALES RODRIGUEZ, JESUS
FACILITY NUMBER: 444416809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
102416.3(a)

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102416.3 Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change..

This requirement was not met as evidenced by:
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The Licensee will submit a report indicating the timeline for renovations and how children will remain safely in care while they are on-going. An estimation of when renovations will be completed shall be submitted.
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The Licensee has renovations on-going for his mobile home (including wall renovation, installation of sliding door, and renovation to stair case/patio), which was not reported to the Department, which poses a potential risk to the health, safety, and personal rights of children in care.
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The Licensee is to notify the Department of renovations to the home that impact the day care area as well as for any extended closures of the day care home.

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
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