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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700269
Report Date: 12/14/2022
Date Signed: 12/15/2022 08:28:13 AM

Document Has Been Signed on 12/15/2022 08:28 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CERON FAMILY CHILD CAREFACILITY NUMBER:
367700269
ADMINISTRATOR:JULIA CERONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 339-5858
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
12/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Julica CeronTIME COMPLETED:
12:00 PM
NARRATIVE
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On 12/14/2022, Licensing Program Analyst (LPA) Carol Heath conducted a follow-up complaint inspection of the Ceron Family Child Care and met with the Licensee Julia Ceron for a Case Management- Deficiencies inspection involving a complaint dated 12/6/2022. Upon arrival, there were 8 children.
Description of the situation:
On 12/8/2022, during the 10 days complaint visit, LPA Heath requested the Licensee to submit her facility roster by 12/9/2022. LPA received the old facility from 2018. On 12/14/2022, LPA Heath arrived to the facility and reviewed children files and took pictures on LIC 700. According to the licensee she has 15 children enroll to the program (3 children are school age and 12 children are from 1.5 years old to 5 years old), but she could not find all the paperwork at the time.
LPA Heath also observed a lady (Bertha Gallardo) was in the facility. LPA Heath checked the Guardian to make sure she is associated and Eligible. LPA told the Licensee that her assistant can not be alone with children until she has her CPR/First Aid and Mandated Reporter Training.
Based on observation and interview today, the preponderance of evidence has been met, Therefore the above allegation is Substantiated
Deficiency cited. Type “B” California Code of Regulation, Title 22, Division 12 Chapter 1 Article 06.
An exit interview was conducted and a copy of this report, a notice of site inspection, and appeal rights were discussed and given to Licensee Julia Ceron.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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Document Has Been Signed on 12/15/2022 08:28 AM - It Cannot Be Edited


Created By: Carol Heath On 12/14/2022 at 11:41 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CERON FAMILY CHILD CARE
FACILITY NUMBER: 367700269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2022
Section Cited
CCR
102421

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102421 Child's Records
a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not meet as evidenced by:
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The licensee will have all the parents to review and fix all the paper and fill out a new roster and email to the LPA.
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Based on observation and interviews, the
licensee did not ensure child's records, which poses a potential Health, Safety or Personal Rights risk to persons in care.
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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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022


LIC809 (FAS) - (06/04)
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