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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233008548
Report Date: 02/03/2023
Date Signed: 02/03/2023 04:43:01 PM

Document Has Been Signed on 02/03/2023 04:43 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CEJA, BEATRIZ FCCHFACILITY NUMBER:
233008548
ADMINISTRATOR:CEJA, BEATRIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 485-1135
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Beatriz CejaTIME COMPLETED:
03:25 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
A Case Management inspection was made to the facility by Licensing Program Analyst (LPA), Leticia Rosales-Meza. LPA met with Licensee, Beatriz Ceja. The Case Management inspection was conducted regarding the following: Children files were reviewed and 2 out of 4 files of infants under the age of 12 months, Child 1 and Child 2 are under 12 months of age and files did not contain form LIC9227.

During today’s inspection the licensee and assistant were supervising 9 children, operating within the licensed capacity and ratio requirements. Licensee provided a current roster of children in care as required.


The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Exit interview conducted and report was reviewed with the Licensee, Beatriz Ceja.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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 02/03/2023 06:09 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/03/2023 04:49 PM


Created By: Leticia Rosales On 02/03/2023 at 02:36 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CEJA, BEATRIZ FCCH
FACILITY NUMBER: 233008548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
102425(c)

1
2
3
4
5
6
7
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

1
2
3
4
5
6
7
Licensee stated that she will ensure that parents of all infants up to 12 months of age complete the LIC 9227 and put in child's file. Licensee stated C1 & C2 are disenrolled, so unable to provide LIC 9227 to parent.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 4 files of infants under the age of 12 months. Child 1 and Child 2 are under 12 months of age and files did not contain form LIC9227 which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Alexis Hollon
LICENSING EVALUATOR NAME:Leticia Rosales
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2