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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628971
Report Date: 07/27/2022
Date Signed: 07/27/2022 02:13:33 PM

Document Has Been Signed on 07/27/2022 02:13 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, 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: 24CENSUS: 6DATE:
07/27/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rose Dorvilus TIME COMPLETED:
02:15 PM
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On 7/27/22 at 1:00pm, Licensing Program Analysts (LPAs), David Miller and Martha Malane conducted an unannounced Plan of Correction (POC) inspection at the facility. Purpose of this inspection is to ensure the citation issued 7/20/22 was corrected. Upon arrival, LPA met with Licensee, Rose Dorvilus and proceeded to tour the facility. Upon arrival, LPAs met with licensee's helper. LPA Miller called the licensee at 1:03pm. Licensee stated that she was a few minutes from the facility. Licensee arrived at 1:22pm and stated that she was at the dentist for an appointment at 11:45am.

There were six (6) daycare children, licensee's child (10-year old), licensee's helper and licensee present. LPA observed capacity to be within the limitations set forth on the license.

The following citation issued on 7/20/22 was corrected as follows:
Licensee submitted a written summary of capacity/ratio video from CCL website https://ccld.childcarevideos.org/. Child files were reviewed and contain signed LIC9224 Acknowledgement of Licensing Report.

Exit interview conducted with the Licensee, Rose Dorvilus. 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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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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