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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311836
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:11:27 PM

Document Has Been Signed on 01/24/2024 12:11 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
ORANGE CO CHILD CARE, 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: 14CENSUS: 6DATE:
01/24/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Maria AldanaTIME COMPLETED:
12:20 PM
NARRATIVE
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An inspection was conducted on this date by Licensing Program Analyst (LPA) Nunez for the purpose of reviewing licensee on a Compliance Plan.

LPA met with Licensee Maria Aldana. LPA took census, there were 2 infants, and 4 preschool age children with 1 assistant in the childcare area. Licensee and assistant were in the living with the children. LPA observed all children awake in the living room watching television. Licensee’s spouse was in the home and observed spouse walk through the living to leave to work. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

LPA asked Licensee for the children’s files for review and Licensee’s only had 2 files out of 6 children. Licensee stated she did not have the other children’s files due to Licensee not having copies of the forms that are required. Licensee also did not have the sleeping logs for the 2 infants that were present. Licensee did have the Sleeping Plan (LIC 9227) for the 2 infants that were present. LPA gave Licensee copies of all the required forms that are required in children’s files both in English and Spanish.



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: Child's Records 102421(b) and Infant Safe Sleep 102425(j)(2)(D) see LIC 809D.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALDANA, MARIA
FACILITY NUMBER: 304311836
VISIT DATE: 01/24/2024
NARRATIVE
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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.

End of Report

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/24/2024 12:11 PM - It Cannot Be Edited


Created By: Aiddee Nunez On 01/24/2024 at 11:07 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: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2024
Section Cited
CCR
102421(b)

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(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
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Licensee agreed to send proof of file to LPA by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During children file reviews, LPA observed 2 out of 8 children present did not have a file which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
02/07/2024
Section Cited
CCR102425(j)(2)(D)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
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Licensee agreed to document infant safe sleep every 15 minutes and submit prooof to LPA by POC due date.
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Based on observation,and record review, the licensee did not comply with the section cited above. During children file review, LPA observed children in care were missing LIC 700 Identification and Emergency Information which poses/posed a potential health, safety or personal rights risk to persons 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:Thuy Ho
LICENSING EVALUATOR NAME:Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
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