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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311836
Report Date: 08/16/2023
Date Signed: 08/16/2023 10:44:23 AM

Document Has Been Signed on 08/16/2023 10:44 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALDANA, MARIAFACILITY NUMBER:
304311836
ADMINISTRATOR:ALDANA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 458-7780
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/16/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria Aldana, LicenseeTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit to determine compliance as per non compliance conference of 02/24/23.
Licensee has completed technical support program assistance in April 2023.
Upon entrance LPA observed three children in care. One child was in infant who was asleep in the bedroom, the door was open. The two other children were in the living room interacting with Assistant. One of the two children is also considered an infant.
Licensee's husband came downstairs but stated he was not assisting with day care. Also present was Licensee's mother who was present in the facility but not providing care.
During visit Licensee was also providing care and supervision so LPA had to wait for licensee to complete with daily tasks.
LPA requested lic 9227 for Child3(C3) but could not locate it. LPA spoke with mother of two infants via telephone and was advised that she had submitted file to licensee, including an infant sleep plan but she remembered child not turning at time of completion and mentioned that child just began to turn.


Based on observation, and interviews the following deficiency is cited under the California Code of Regulations Title 22 division 12 Chapter 1; 102425(c)Infant Sleep plan

An exit interview was conducted with licensee, Maria Aldana in Spanish Appeal Rights were explained. 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 to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/16/2023 10:44 AM - It Cannot Be Edited


Created By: Pat Rivas On 08/16/2023 at 10:16 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: ALDANA, MARIA
FACILITY NUMBER: 304311836

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2023
Section Cited
CCR
102425(c)

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Infant Safe Sleep Plan
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. The Individual Infant Sleeping Plan The Department for review. This regulation was
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licensee will provide copy of infant safe sleep plan for C3
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 shall be maintained in the infant’s file and shall be available to not met as evidenced by interview with Licensee who could not locate lic 9227 for C3mother stated she completed form this is a potential personal rights and safety hazard to 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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023


LIC809 (FAS) - (06/04)
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