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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313690
Report Date: 01/08/2024
Date Signed: 01/10/2024 04:08:23 PM

Document Has Been Signed on 01/10/2024 04:08 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:AVALOS, MARIAFACILITY NUMBER:
304313690
ADMINISTRATOR:AVALOS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(657) 565-1911
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Licensee, Maria AvalosTIME COMPLETED:
04:00 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
Licensing Program Analysts LPA Nunez and LPA Sun conducted an unannounced case management investigation regarding an observation which occurred on 1/3/24. LPAs observed 8 children preschool children age children with licensee and assistant in the home.

A review of facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

This is a case management visit that is a follow-up from the visit that was made on 1/3/2024 by Licensing Program Analyst (LPA) Nunez. On 1/3/2024 LPA Nunez observed an assistant in the home helping with the cooking and cleaning. The assistant did not have a copy of proof of immunization against pertussis, measles, influenza and TB test results. The assistant’s name was on the personnel summary report. LPAs informed the Licensee of the purpose of the visit.



Based on LPAs' record review, the following deficiency was observed in accordance to California Code and Regulations, Tittle 22, Division 12, Health and Safety (H&S) 1597.622 a technical violation was given please see LIC9102.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maria Avalos.

(End of Report)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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 1