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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310810
Report Date: 10/05/2023
Date Signed: 10/12/2023 09:19:20 AM

Document Has Been Signed on 10/12/2023 09:19 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KEOUGH-SOMMA, GINAFACILITY NUMBER:
304310810
ADMINISTRATOR:KEOUGH-SOMMA, GINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 235-7946
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
10/05/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Gina K SommaTIME COMPLETED:
01:00 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
LPA Bootorabi conducted an unannounced visit to clear citations with the licensee.

During today's visit the census was as followed: 2 infants and 5 Children over the age of two with 1 adult working directly with the children.

LPA observed children playing in the living room upon entry.

LPA was not able to clear the citation 102418(g)(1) The licensee stated they would be contacting the families to ensure they provide copies of updated immunization records. A consultation was provided and a copy of an updated CDPH 286 (11/22) was provided to the licensee.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12
were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:102418(g)(1)

An exit interview was conducted with Gina K Somma. Appeal Rights were explained.
During the exit interview, the Licensee Gina K.S , confirmed that there are no Registered Sex Offenders living in the facility.

The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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 10/12/2023 09:19 AM - It Cannot Be Edited


Created By: Araceli Bootorabi On 10/05/2023 at 11:47 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KEOUGH-SOMMA, GINA
FACILITY NUMBER: 304310810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2023
Section Cited
CCR
102418(g)(1)

1
2
3
4
5
6
7
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations... (1) This requirement includes updating ... PM 286 ... when the child is due to receive required immunizations after enrollment
1
2
3
4
5
6
7
The licensee stated that she will be working with the families to ensure she is receiving the immunizations records for the children enrolled. The licensee will have the records complete by 10/12/2023.
8
9
10
11
12
13
14
Based on observation, interview and record review, the licensee did not comply with the section cited above by means of not having completed immunization records for C1 and C2 during today's visit.
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:Patricia Magana
LICENSING EVALUATOR NAME:Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023


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