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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845376
Report Date: 01/16/2024
Date Signed: 01/16/2024 05:29:31 PM

Document Has Been Signed on 01/16/2024 05:29 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:BURGOS FAMILY CHILD CAREFACILITY NUMBER:
364845376
ADMINISTRATOR:BURGOS, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 275-0342
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
01/16/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Yolanda Burgos TIME COMPLETED:
05:45 PM
NARRATIVE
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On 01/16/2024, Licensing Program Analyst (LPA) Aman Sharma conducted a Case Management-Legal/Non-Compliance inspection. This inspection is in agreement with, and as a result of a Non-Compliance Conference, that took place on September 14, 2023, due to concerns associated with the facility history and citation(s) issued. The citation(s) issued were regarding: Operation of a Family Child Care Home (FCCH), Infant Safe Sleep, Staffing Ratio and Capacity, Mandated Reporter Training, Personnel Requirements, General Provisions and Definitions.

LPA Sharma met with the licensee, Yolanda Burgos toured home and collected a census of the children. The following was observed:

· Facility is operating within the terms of their license during today's inspection
· Facility is operating within ratios
· LPA observed personal rights being accorded to the children in care
· Adequate supervision is being provided
. Personnel Requirements are being met

LPA reminded licensee of the deadline of 10/14/23 and 12/14/23 and discussed why licensee has not reached out to LPA regarding the trainings. Licensee stated that she was under the impression that she just needed to have proof of training available for review when LPA comes out to the home. No trainings were provided as proof during todays inspection. Upon further discussion, it was disclosed that there was a training with an outside vendor that licensee had done, but could not find proof of.


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SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: BURGOS FAMILY CHILD CARE
FACILITY NUMBER: 364845376
VISIT DATE: 01/16/2024
NARRATIVE
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Licensee is given the hard deadline of Friday, JANUARY 26, 2024 to get LPA a written notice of a scheduled training(s), proof of any trainings done after 09/14/2023, proof of enrollment in TSP (Technical Support Program), as licensee stated she has, and a log of all trainings done.

Civil Penalties have been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

An exit interview was conducted, and report was reviewed with the licensee, Yolanda Burgos.
A Notice of Site Visit was issued and must be posted in a prominent location for the next 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
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Document Has Been Signed on 01/16/2024 05:29 PM - It Cannot Be Edited


Created By: Aman Sharma On 01/16/2024 at 05:11 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BURGOS FAMILY CHILD CARE
FACILITY NUMBER: 364845376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2024
Section Cited
CCR
102417(g)(4)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to(4) Poisons, detergents, cleaning compounds, medicines, firearms & other items which could pose a danger if readily available to children shall be stored where
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Immediately, licensee removed all listed hazards and sharps.
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they are inaccessible to children. This requirement is not met as evidenced by: LPA observed knives in the kitchen sink, multiple botles of laundry detergent on the floor in the garage, baking powder in a cabinet of the garage accessible to children. In the on-limit outdoor area of the home, 3 cracked play-
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houses. Tools like a rake and shovel near the playhouses for the children in care, 3 cracked tubes to a water table, an unlocked shed containing muliple hazards and sharps, a cooler of beer on the ground, accessible to children, and dog feces on the floor.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
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