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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700642
Report Date: 06/19/2023
Date Signed: 06/19/2023 02:51:33 PM

Document Has Been Signed on 06/19/2023 02:51 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:TOLEDO RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197700642
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Gretchen Toledo-RodriguezTIME COMPLETED:
03:06 PM
NARRATIVE
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Licensing Program Analyst (LPA) Justin Dorsey, met with Licensee, Gretchen Toledo-Rodriguez for a Case Management - Deficiencies inspection.

During the inspection the following was observed:
  • LPA Dorsey observed uncleared adult #1 in the home. Per licensee the Adult was only in the home to help watch the children while the Capacity Increase Inspection was being conducted. LPA Dorsey observed on Guardian that Adult #1's background clearance application was closed due to incomplete application.


Facility cited Type A deficiency, according to California Code of Regulations Title 22. LIC809D issued for deficiency. Immediate $100 civil penalty was assessed 06/19/23.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Exit interview conducted. Report and Appeal rights were reviewed with Licensee Gretchen Toledo-Rodriguez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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Document Has Been Signed on 06/19/2023 02:51 PM - It Cannot Be Edited


Created By: Justin Dorsey On 06/19/2023 at 02:02 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: TOLEDO RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700642

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2023
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d)(1) (d) All individuals...shall prior to working, residing, or volunteering in a licensed facility...Obtain a California clearance or a criminal record exemption as required by the Department...This requirement is not met as evidenced by:
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Per Licensee Adult #1 will not care for children until thier fingerprints have been cleared on Guardian.
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Based on observation uncleared Adult #1 was watching children in the home, which poses an immediate Health, Safety or Personal Rights risk to children 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:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023


LIC809 (FAS) - (06/04)
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