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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005131
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:14:22 PM

Document Has Been Signed on 09/12/2024 01:14 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BALDERRAMA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
372005131
ADMINISTRATOR/
DIRECTOR:		YATES, ANDREAFACILITY TYPE:
850
ADDRESS:709 SAN DIEGO ST.TELEPHONE:
(760) 757-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 23DATE:
09/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:59 AM
MET WITH:Andrea Wood TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On the above date and time, Licensing Program Analyst (LPA) Kelly Gerth conducted an unannounced visit to the facility. During this time, LPA Gerth conducted a separate case management visit.

During the visit, LPA Gerth reviewed files, gathered documents and spoke to staff members, including Site Director Andrea Wood.

Based on interview and evidence gathered, it was revealed that that all enrolled and newly enrolled families had not been provided a copy of Licensing reports containing Type A deficiencies in the last 12 months.

Additionally it was revealed that 3 separate unusual incidents have occurred at the Child Care Center (CCC) since April 2024 and have not been disclosed to CCLD as required by the Title 22 Licensing Regulations.

For the above reasons, the CCC is being cited for deficiencies, See LIC809D for cited deficiencies of the California Code of Regulations, Title 22.

An exit interview was conducted. The appeal rights were discussed and provided along with a copy of this report to Site Director Andrea Wood, on this date. A Notice of Site Visit provided and reminded to be posted.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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 2
Document Has Been Signed on 09/12/2024 01:14 PM - It Cannot Be Edited


Created By: Kelly Gerth On 09/12/2024 at 12:26 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: BALDERRAMA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 372005131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2024
Section Cited
CCR
101212(d)

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101212(d) Reporting Requirements
Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirment was not met as evidenced by;
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Licensee agrees to submit the 3 unusual incidents via an LIC 624 to CCLD within 7 days, disclosing the 3 unusual incidents which occurred between 4/1/24 and 9/12/24, in writing within the next 7 days.
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Based on interview and record review, the CCC did not meet this regualtion in 3/3 recent unusual incidents occuring at the CCC within the last 12 months were not reported to CCLD.
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Type B
09/12/2024
Section Cited
HSC1596.8595(d)(2)

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1596.8595(d)(2) Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services(2) Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing document that the licensee has received during the prior 12-month period that pertains to a conference conducted by a local licensing agency management representative with the licensee in which issues of noncompliance are discussed.This requirement has not been met as evidenced by;
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By COB 10/11/24, Licensee agrees to provide proof to CCLD that all families have been provided copies of any licensing document that the licensee has received during the prior 12-month period, resulting in a Type A Deficinecy.
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Based on interview and record review, the licensee did not comply with the section cited above where the CCC could not provide evidence that newly enrolled families/children have been provided copies of any licensing document that the licensee has received during the prior 12-month period resulting in a Type A deficiency, which poses/posed a potential health, safety or personal rights risk to persons 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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024


LIC809 (FAS) - (06/04)
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