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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 12:23:52 PM

Document Has Been Signed on 11/08/2023 12:23 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
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: DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Jesus Morales RodriguezTIME COMPLETED:
12:33 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Jesus Morales Rodriguez, and explained purpose of visit, to follow-up on transportation of a school-age child.

During visit conducted 11/8/2023 at approximately 8:10AM, the Licensee, Jesus, informed LPA that a child walked to Cesar Chavez Middle School. LPA conducted interview with the child, on the same day, and was informed that he was driven to school by a high-school age minor who lives in the home. The child indicated that he does not walk to school.

LPA advised Jesus that minors shall not transport children to school. Children in care shall be supervised by an adult, meaning a person who is 18 years old or older. While the child was being transported to school, the child was under the supervision of a minor as no adults were present.

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 12:23 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/08/2023 at 12:01 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
, 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
102417(a)

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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence...

This requirement was not met as evidenced by:
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The Licensee is to stop allowing the minor to transport children and will submit a list of all adults that will transport children. List of adults shall also include copy of drivers license and current First-Aid/CPR certifications.
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The Licensee and/or another adult did not transport a child to school and instead had a minor transport the child to school, which poses an immediate risk 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: 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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