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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313633
Report Date: 12/07/2023
Date Signed: 12/07/2023 11:20:18 AM

Document Has Been Signed on 12/07/2023 11:20 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALGAMA, DONA & DONFACILITY NUMBER:
304313633
ADMINISTRATOR:ALGAMA, DONA & DONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 573-1080
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Dona AlgamaTIME COMPLETED:
11:35 AM
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Licensing Program Analysts (LPAs) Anna Chan and Karen Navar conducted a Plan of Correction (POC) inspection in response to a 2 Type B violation issued on 11/28/23, 102417(g)(4)(B)1 Operation of A Family Child Care Home and 102417(g)(4)(C) Operation of A Family Child Care Home were firearms are not stored separately with the pins and ammunition.

LPAs met with Licensee Dona Algama. Current census observed was 10 children and 2 staff plus the licensee and 1 male adult resident.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The areas cited were re-inspected and found to be corrected. Pins and ammunition were stored in a separate and locked case and stored individually from firearms. Deficiencies cleared.

No further action needed at this time. POC letters given, and all corrections have been received at this time.

Exit interview conducted and report was reviewed with the Licensee Dona Algama. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

End of Report
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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