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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334817646
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:44:15 PM

Document Has Been Signed on 03/07/2024 12:44 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GILBERT FAMILY CHILD CAREFACILITY NUMBER:
334817646
ADMINISTRATOR:GILBERT, ESMERALDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 880-8753
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
03/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Esmeralda GilbertTIME COMPLETED:
01:00 PM
NARRATIVE
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On March 7, 2024 at 11:40 am, Licensing Program Analysts (LPA) Jessica Rubio and Kelly Gerth arrived unannounced to Gilbert Family Child Care Home (FCCH) and met with Licensee Esmeralda Gilbert. The purpose of the visit was to speak to the licensee regarding a recent arrest of an adult resident (A1) who is living in the home. LPAs conducted a census of the FCCH, obtained a current roster, and interviewed licensee and A1.

LPA’s provided licensee with the option of placing her license into inactive status until the situation is resolved. Licensee explained that she will await the outcome of the legal case. Licensee stated she was unaware of the need to report A1’s arrest as A1 has not yet been convicted of any crimes.

Community Care Licensing (CCL) was notified that an adult resident (A1) of the facility had been arrested. Licensee did not notify or provide an unusual incident report to CCL regarding A1’s arrest, which poses a potential health, safety, or personal rights risk to children in care.

The facility is being cited for Title 22 Regulation Section 102416.2 (b). See LIC 809D for cited deficiency.

An exit interview was conducted, this report and appeal rights were discussed and provided to Licensee Esmeralda Gilbert. A notice of site visit was also given and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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 03/07/2024 12:44 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 03/07/2024 at 12:26 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GILBERT FAMILY CHILD CARE
FACILITY NUMBER: 334817646

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
102416.2(b)

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102416.2 Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement was not met as evidenced by:
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Licensee stated she will provide a written statement to LPA that licensee now understands reporting requirements and will report accordingly.
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Based on interviews that an adult resident (A1) of the facility was arrested and licensee did not notify the department, which poses a potential health, safety and 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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