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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313638
Report Date: 10/06/2021
Date Signed: 10/06/2021 04:38:10 PM

Document Has Been Signed on 10/06/2021 04:38 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CASTILLO, GLORIAFACILITY NUMBER:
304313638
ADMINISTRATOR:CASTILLO, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 737-4569
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
10/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Gloria Castillo - LicenseeTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Odom conducted a case management inspection in response to a self-reported incident. Licensee and LPA toured the facility. LPA observed a total of 4 children; 1 infants, preschool child napping and 2 school age children with Licensee and 2 assistants.

A review of the Facility Personnel Report Summary on this date (10/4/2021) indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/25/2021 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 09/22/2021 child #3 (C3) stated, during a phone conversation with parent while at the childcare C3 told parent that Licensee hit child while in the childcare. During today’s visit, LPA obtained an updated copy of the LIC9040 Children’s Roster, and interviewed licensee, 2 assistant and 2 children. Due to insufficient information available at this time, the reported incident needs further investigation.

Exit interview was conducted with Licensee Gloria Castillo. The Notice of Site Visit was posted. Licensee was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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