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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500499
Report Date: 11/09/2023
Date Signed: 11/09/2023 12:24:53 PM

Document Has Been Signed on 11/09/2023 12:24 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GROSS GAITAN, MARITZAFACILITY NUMBER:
574500499
ADMINISTRATOR:GROSS GAITAN, MARITZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 296-2912
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
11/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Maritza Gross GaitanTIME COMPLETED:
12:40 PM
NARRATIVE
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On 11/9/23, Licensing Program Analysts (LPA's) Carla Polanco and Jennie Tedlos met with Licensee Maritza Gross Gaitan to follow up on a phone call received by the Department on 11/6/23. During today's visit the facility was toured. Present were 13 children being supervised by Licensee and one qualified assistant.

Per LPA interview with Licensee she had been completely absent from her childcare facility from October 31, 2023 through November 3, 2023 due to an emergency. Licensee states that during her absence, she left her assistants in charge of her daycare operations.

LPA informed Licensee Maritza Gross Gaitan, that this report dated November 9, 2023, documents a Type A citation, which is an immediate Health and Safety, or Personal Rights risk to persons in care. A separate 809-D page was issued for the deficiency.

An exit interview was conducted, and the report was reviewed with Licensee. LPA Polanco posted a notice of site visit. Licensee understands the notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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 11/09/2023 12:24 PM - It Cannot Be Edited


Created By: Carla Polanco Rivera On 11/09/2023 at 11:01 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
102417(a)

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The licensee shall be present in the home ...... children in care are supervised at all times. When... temporarily absent from the home... his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met by evidenced by:
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Licensee states that anyime she will be absent more than 20% of her daily daycare operation hours, she will close down her facility.
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Upon interview with Licensee Maritza Gross Gaitan, it was revealed that Licensee was not present in the home from October30, 2023 through November 3, 2023.
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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:Karyn Guerra
LICENSING EVALUATOR NAME:Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023


LIC809 (FAS) - (06/04)
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