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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313924
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:34:07 PM

Document Has Been Signed on 07/22/2022 12:34 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:MORRIS, EVELYNFACILITY NUMBER:
304313924
ADMINISTRATOR:MORRIS, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 923-5235
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
07/22/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Everlyn Morris, licenseeTIME COMPLETED:
01:10 PM
NARRATIVE
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On 07/22/2022 Licensing Program Analyst, Stella Gutierrez made an unannounced case management - annual continuation inspection. LPA, Gutierrez was met by Licensee, Evelyn Morris who was explained the reason for today's visit. LPA observed 10 children present ( Licensee stated there are 03 children in care under the age of 2 years) being supervised by Licensee and assistant Zaida Bravo.

A review of the Facility Personnel Report Summary conducted on 07/22/2022 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Licensee 07/22/2022 was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

On 07/18/2022 LPA, Gutierrez conducted an unannounced required annul inspection. Licensee was not present on 07/18/2022 and Licensee's two assistants did not have access to the children's files and assistants did not have personnel paperwork for LPA review.

During today's inspection LPA reviewed 10 files for the children present, 2 additional files for the children that are not present and the personnel records for both Licensee and Assistant. LPA confirmed that there is one staff member present today and on 07/18/2022 to have a current CPR/First aid certification that expires on 03/12/2024. Licensee was reminded that she must be present at the facility at least 80% of time during operational hours. Page 1 of 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MORRIS, EVELYN
FACILITY NUMBER: 304313924
VISIT DATE: 07/22/2022
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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Exit interview conducted and report was reviewed with the licensee, Everlyn Morris. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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