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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416809
Report Date: 11/08/2023
Date Signed: 11/08/2023 10:17:39 AM

Document Has Been Signed on 11/08/2023 10:17 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:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Jesus Morales RodriguezTIME COMPLETED:
10:27 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Jesus Morales Rodriguez, to conduct case management inspection. Upon arrival, LPA was admitted into the home by a high-school age minor who lives in the home and observed there were six children (four infants, one preschool-age, one school-age) present with one adult, Estephania. Jesus was not present at the home upon arrival and Estephania states that he is dropping off school-age children. LPA observed a school-age child left for school at approximately 8:20AM and Jesus states that the child walks to school.

During today's inspection, LPA toured inside of the home as recently submitted facility sketch indicated that a bedroom has been added to the home. LPA observed there are now three bedrooms in the home and Jesus identified the adults/minors living in the rooms.

LPA advised Jesus that today he is over capacity, as a family child care home shall not have more than three infants (under the age of two years old), while additional children are in care. LPA advised that Licensee's children shall count in the ratio until children turn 10 years of age. LPA observed six children in care; one school-age, one preschool-age, and four infants and reviewed Section 102416.5 Staffing Ratio and Capacity regulations with Jesus. A copy was provided to Jesus.

As a result of today's inspection, a deficiency has been 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: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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 2
Document Has Been Signed on 11/08/2023 10:17 AM - It Cannot Be Edited


Created By: Cortney Nelson On 11/08/2023 at 09:11 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: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
102416.5(a)

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102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement was not met as evidenced by:
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Corrected during visit, one infant was picked up while LPA was present at the home. LPA requested Jesus submit plan of correction, indicating the dates and times that infants will be in care to follow ratio and capacity requirements.
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The Licensee did not follow capacity and ratio requirements as there were six children in care (four infants, one preschool-age, one school-age), which poses an immediate risk to the health, safety, and personal rights of children in care.
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Schedule of infants to be submitted to the Department by the end of day 11/9/2023.

LPA reviewed requirements of AB633 and required LIC9224 signature from parents within 24 hours.

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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: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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