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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820224
Report Date: 08/09/2023
Date Signed: 08/09/2023 07:17:55 PM

Document Has Been Signed on 08/09/2023 07:17 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:DELGADO FAMILY CHILD CAREFACILITY NUMBER:
364820224
ADMINISTRATOR:ROSA-VIRGIL DELGADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 732-5387
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
08/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Rosa DelgadoTIME COMPLETED:
07:35 PM
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On 08/09/23 at 2:30 p.m. Licensing Program Analyst (LPA) Blanca Ruiz arrived at the facility to conduct a Case Management inspection for the purpose of following up on a Health and Safety check of daycare children at the facility. LPAs met with licensee, Rosa Delgado, also present during this inspection were licensee's adult relatives, Alma Romero, and Valerie DeLeon. This inspection was conducted in Spanish per licensees' request. LPA conducted a tour of the facility and census was taken. Upon arrival to the facility, 5 children were observed present. The children were observed arriving from school.
A prior inspection was conducted on 04/20/23, during this inspection criminal record clearances and/or exemptions were reviewed. However, licensee did not notify the department that an adult family friend was allowed to live at the facility without a criminal record clearance and/or exemption. The facility is in violation of Title 22 Section 102370 Criminal Record Clearance. During current inspection, LPA provided information and instructions to the licensee to correct the violation for not having the adult resident fingerprinted prior to moving into the home. Documentation was provided for licensee to follow up immediately to resolve the issue.

On 08/09/23, licensee informed LPA that outside agency visited the facility on 08/04/23 and conducted an interview with both licensee assistant and children. Licensee forgot reporting incident(s) to Community Care Licensing (CCL). Licensee failed to report an unusual incident that occurred at the facility that jeopardized the Health and Safety of the children in care. Licensee was reminded to be in close communication with Community Care Licensing (CCL) to address any questions, concerns and/or to verify substantial compliance. Lastly, licensee was advised to contact the Duty Officer available Monday-Friday 8:00 a.m. to 5:00 p.m. to obtain clarification if needed at (951)782-4200.


Please See LIC809-D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: DELGADO FAMILY CHILD CARE
FACILITY NUMBER: 364820224
VISIT DATE: 08/09/2023
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LPA informed licensee, Rosa Delgado that this report dated 08/09/23 documents 1 Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the Health, Safety, or Personal Rights of children in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) was provided to facility during this inspection. The Lic 9224/Type A citation must be provided to parents/guardian of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for the verification.


Exit interview was conducted and report was reviewed with licensee, Rosa Delgado. A Notice of Site Visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2023 07:17 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 08/09/2023 at 06:18 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: DELGADO FAMILY CHILD CARE
FACILITY NUMBER: 364820224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2023
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department ... as specified in Section 102370(j)
This requirement was not met as evidenced by:
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Licensee agrees to complete the Criminal Record Clearance for the following uncleared adult (family friend): Adult 1. All pertinents documents were provided during this inspection.
In addition, licensee is to submit a written statement of understanding of the importance of criminal record clearances for adults before they live or work in the home.
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Per licensee's own statement the following family friend:
Adult 1 has lived at the license facility without criminal record clearance for approximately 2 years ( 09/2021).
This is an immediate Health and Safety risk to the children in care. A CIVIL PENALTY OF $500.00 DOLLARS has been assessed.
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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:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2023 07:17 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 08/09/2023 at 06:31 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: DELGADO FAMILY CHILD CARE
FACILITY NUMBER: 364820224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2023
Section Cited
CCR
102416.2(d)(1)

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(1) Health and Safety Code Section 1597.467(b)(1) provides in part:" A report shall be made to the department by tof the next working day following the occurrence during the operation of family day care home of…the…events." elephone or fax during the department's normal business hours before the close
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Licensee agrees to submit a written statement regarding her understanding of Reporting Requirements. LIC 624B regarding incident(s) in question have been obtained during this inspection.
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This requirement was not being met as evidenced by:
Licensee’s fail to report verbally and in writing, via the Unusual Incident Report form (LIC624B), an incident involving a visit for an outside agency pertaining to daycare activities. This poses a potential Health, Safety or Personal Rights risk to the children in care.
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Type B
08/31/2023
Section Cited
CCR102369(b)(9)

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(9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care. This requirement is not met as evidenced by:
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Licensee agrees to submit proof of TB clearance for adult individual to the Department on or by POC due date. Licensee understands all adults around the children in care are required to have a TB clearance available for review.
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Based on the record review, the licensee did not have records for adult individual ( Adult 1) who resides at the facility for 2 years ago (09/2021). This poses a potential Health, Safety & Personal Rights risk to the children in care.
Adult N.1 resident did not have proof of current TB clearance on file during this inspection.

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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:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


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