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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304200518
Report Date: 01/30/2024
Date Signed: 01/30/2024 09:22:58 AM

Document Has Been Signed on 01/30/2024 09:22 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RUVALCABA, ELVAFACILITY NUMBER:
304200518
ADMINISTRATOR:RUVALCABA, ELVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 993-9862
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
01/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee Elva RuvalcabaTIME COMPLETED:
09:35 AM
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On 1/30/24 at 8:45am, a Case Management visit was conducted to amend the LIC421BG (Civil Penalty) for visit conducted on 1/24/24, and deliver the amended report (LIC421BG) to facility representative. Census was taken. There were 2 children and licensee upon arrival. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

On 1/24/24, licensee provided the names of 2 adults living in the home to LPA, when livescan copy was given to LPA on 1/25/24, LPA discovered that the names were incorrect. During today's visit, a copy of the amended LIC421BG were given to licensee.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Chan discussed and reviewed the amended report to licensee Elva Ruvalcaba. The amended report supersedes the previous report, and the amended report is to be kept in facility files for 3 years.

An exit interview was completed with licensee, Elva Ruvalcaba. The LIC 809 report was reviewed and discussed. The Licensee was provided a copy of the appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights. A "Notice of Site Visit" was issued. Notice of Site Visit must remain posted for 30 days. Failure to do so will result in a $100.00 civil penalty.



End of Report
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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