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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628971
Report Date: 07/20/2022
Date Signed: 08/09/2022 08:52:51 AM

Document Has Been Signed on 08/09/2022 08:52 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DORVILUS, ROSE ERTHA FAMILY CHILD CAREFACILITY NUMBER:
376628971
ADMINISTRATOR:ROSE ERTHA DORVILUSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 394-9731
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 14TOTAL ENROLLED CHILDREN: 26CENSUS: 9DATE:
07/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Rose Ertha Dorvilus TIME COMPLETED:
03:00 PM
NARRATIVE
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On 07/20/2022 at 1:10PM, Licensing Program Analysts (LPAs), David Miller and Martha Malane conducted an unannounced Inspection and met with the licensee Rose Dorvilus. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee’s helper, Roselene Ceide. Cedie was observed supervising nine (9) children alone; one infant, four preschoolers, and four school aged kids (See Deficiency Cited LIC809-D). Licensee arrived at 1:32PM. Licensee stated that she had just stepped out from the house to run errands. During a roster review with the licensee, it was noted that two children did not have enrollment documents. Licensee stated that she did not get enrollment documents from the mother because she was just watching the two children for the day (See LIC809-D).

LPA David Miller informed licensee, Rose Dorvilus, that this report dated 07/20/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety and personal rights of children in care.

Also, LPA David Miller informed the licensee to provide a copy of this licensing report dated (07/20/2022) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child’s file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Rose Dorvilus.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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 08/09/2022 08:52 AM - It Cannot Be Edited


Created By: David Miller On 07/20/2022 at 02:31 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DORVILUS, ROSE ERTHA FAMILY CHILD CARE
FACILITY NUMBER: 376628971

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2022
Section Cited
CCR
102416.5(e)

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102416.5(e)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by
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Licensee arrived at 1:32pm which placed the facilty in compliance. Licensee stated she will watch Department training video 'How many children can attend a family child care home?' and provide a written summary and a written statement on how she will ensure her facility remains in capacity to CCL by 7/21/22.
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Based on observation and interviews and record review the licensee did not comply with the section cited above, as one helper was supervising nine (9) children alone.
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LPA provided ccld.childcarevideos.org.

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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:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2022 08:52 AM - It Cannot Be Edited


Created By: David Miller On 07/20/2022 at 03:01 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DORVILUS, ROSE ERTHA FAMILY CHILD CARE
FACILITY NUMBER: 376628971

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2022
Section Cited
CCR
102421(b)

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102421(b) The licensee shall maintain in each child's record, a copy of the emergency information form and consent for medical treatment. This requirement is not met as evidenced by:

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Licensee stated she will watch Department training video regarding maintaining and ensuring a facility has all documents for children in care: https://ccld.childcarevideos.org/family-child-care-providers/record-keeping-in-family-child-care/

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Based on observation and interviews and record review the licensee did not comply with the section cited above. There are no records for child #1 and child 2 (See LIC811), which poses a potential health, safety or personal rights risk to persons in care.
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Licensee stated she will provide the Department a written statement summarizing what she viewed on the training video and a written statement on how she will ensure that all required enrollment documents are turned in before a child begins child care. Licensee will provide LPA with this written statement no later than 07/29/2022.

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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:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
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