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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845732
Report Date: 03/22/2021
Date Signed: 03/22/2021 10:50:59 AM

Document Has Been Signed on 03/22/2021 10:50 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEDESMA-PEREZ FAMILY CHILD CAREFACILITY NUMBER:
334845732
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yasmin Ledesma-PerezTIME COMPLETED:
11:00 AM
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**Please note: Due to COVID-19, a tele-inspection is being conducted in lieu of an in-person/physical inspection***

On 3/22/2021 Licensing Program Analyst (LPA) Samuel Lopez contacted Licensee, Yasmin Ledesma-Perez, via Whats App, to address and conclude an issue previously discussed on 1/13/2021. This Case Management Tele-inspection is being conducted to address a separate issue that was discovered while gathering information during an investigating.

LPA Lopez learned that an incident involving a visit from law enforcement occurred on December 23, 2020. The issue was that the licensee, initially, refused to release a child to one of the parents. Although the licensee eventually released the child to the parent, per a legal court order that the licensee had been aware of, the licensee failed to report the incident to the Department. The licensee disclosed the incident only after LPA Lopez made contact on January 13, 2021. The regulations, in Title 22, require licensees to report such incidents to the Department, verbally within 24 hours of its occurrence or knowledge, and in writing within 7 days.

The facility was found to be a violation of the following Title 22 regulation:

102416.2 (b) Reporting Requirement: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(3)(C) that occur during the operation of the family childcare home.

See LIC 809-D for cited deficiency

An exit interview was held, and a copy of this report was sent, via email, to Yasmin Ledesma-Perez.

***This report was sent via email on 3/22/2021. Yasmin has agreed to reply or to acknowledge that she has received it, via read receipt. This will serve as Yasmin’s signature***

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2021
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 03/22/2021 10:50 AM - It Cannot Be Edited


Created By: Samuel Lopez On 03/22/2021 at 09:53 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEDESMA-PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 334845732

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2021
Section Cited
CCR
102416.2(b)

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Reporting Requirement: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(3)(C) that occur during the operation of the family childcare home.
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Licensee agrees to submit a written statement regarding her understanding of Reporting Requirements and the LIC 624B regarding the incident in question. Both are to be submitted to the Riverside Child Care Regional Office by 3/26/2021.
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 This requirement was not being met as evidenced by the licensee’s failure to report verbally and in writing, via the Unusual Incident Report form (LIC624B), the incident involving law enforcement's visit during a custody dispute with a parent. This poses a potential Health, Safety or Personal Rights risk to 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:Aaron Ross
LICENSING EVALUATOR NAME:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2021


LIC809 (FAS) - (06/04)
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