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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334806580
Report Date: 07/29/2024
Date Signed: 07/29/2024 03:22:02 PM

Document Has Been Signed on 07/29/2024 03:22 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BORJA FAMILY CHILD CAREFACILITY NUMBER:
334806580
ADMINISTRATOR/
DIRECTOR:		BORJA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 398-2667
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Maria BorjaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On July 29, 2024, Licensing Program Analyst (LPA) Lorena Valenzuela conducted an unannounced inspection at the family child care and met with licensee Maria Borja. The purpose of this inspection is to discuss information received during a review of an incident that occurred at the facility.

On 07/29/2024, at approximately 1:40pm, LPA arrived at the home and observed Child 1- C1 (infant) in a play pen with a blanket, bottle and sleeping on top of a cot inside the play yard.

Based on interviews and observations, the Department finds the facility did not comply with safe sleep regulations, the facility is cited under Title 22, Section 102425 (b) Infant Sleep.

A signed copy of this report, Appeal Rights, and was provided to Maria Borja.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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Document Has Been Signed on 07/29/2024 03:22 PM - It Cannot Be Edited


Created By: Lorena Valenzuela On 07/29/2024 at 02:30 PM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BORJA FAMILY CHILD CARE
FACILITY NUMBER: 334806580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2024
Section Cited
CCR
102425(b)

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102425 INFANT SAFE SLEEP
b) Cribs or play yards shall be free from all loose articles and objects.
This requirement was not met as evidenced by:
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Licensee removed items from play yard where C1 was sleeping at the time of the inspection. Licensee to send a written statement/summary regarding her understanding of safe sleep regulations to the Department by due date 08/05/2024.
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Per observations, LPA observed C1 (infant) sleeping with blanket, bottle and on top of a cot, inside a play yard, which poses a potential risk to the health, safety and personal rights of the 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:Deborah Mullen
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2024


LIC809 (FAS) - (06/04)
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