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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500499
Report Date: 09/09/2026
Date Signed: 09/09/2026 06:04:53 PM

Document Has Been Signed on 09/09/2026 06:04 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GROSS GAITAN, MARITZAFACILITY NUMBER:
574500499
ADMINISTRATOR/
DIRECTOR:		GROSS GAITAN, MARITZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 296-2912
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee, Maritza Gross GaitanTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
NARRATIVE
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Maritza Gross Gaitan is a Spanish speaking Licensee. Licensing Program Analysts (LPA) Corina Beckby and Elizabeth Santiago spoke with Licensee in Spanish and translated the conversation to English below.

Licensing Program Analysts (LPA) Corina Beckby and Elizabeth Santiago conducted an unannounced annual inspection and met with Licensee, Maritza Gross Gaitan. LPAs were granted entrance into daycare facility by licensee. LIC 126 (SP), Entrance Checklist for Family Child Care Homes, was provided and reviewed with Licensee. Present in the facility was Licensee, assistant, and an adult in the home. Licensee and adult in the home were were supervising 12 children including 2 infants. During inspection licensse's husband arrived to the home. Facility hours of operation are Monday – Friday from 6:00 AM to 6:00 PM.LPA verified that annual fees are current.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA discussed adult present providing supervision for children in care must obtain a criminal record clearance.
Continued on LIC 809-C...
Bettina Engelman
Corina Beckby
DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 09/09/2026
NARRATIVE
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A health and safety inspection was conducted in all areas accessible to children. Upon entry, LPA observed the required postings and verified phones are working. Off-limits areas include the entire upstairs, laundry room, left side of the backyard, front yard, and garage. Off-limits areas will remain inaccessible to children by closed doors, gates, and/or supervision.



Toys appear to be safe and in working order. Home is clean and properly ventilated. The fireplace has tempered glass. Fireplace is appropriately barricaded to prevent access by children. Functioning smoke and carbon monoxide detectors were observed, tested and meet Title 22 regulations. LPA observed a 3A40BC fire extinguisher. Sharp utensils are inaccessible to children. LPA observed the restroom and verified hazardous and toxic items were inaccessible to children in care. Licensee understands she must ensure the safety locks are not broken. The backyard is fenced. There are no bodies of water on the premises. Licensee understands that 100% supervision is required at any unfenced areas. Licensee states there are no weapons in the home.

Licensee provided copy of liability insurance which is $300,000 for every occurrence.

LPA discussed with licensee to maintain a current roster in facility file. LPA discussed to maintain disaster drills on file and must be conducted at least once every six months. LPA reviewed 6 children’s files. Licensee has 3 infants currently enrolled. LPA discussed sleep logs for all infants (under 24 months) must be maintained in children’s files and Infant Individual Sleeping Plans for all infants under 12 months. Preventative health and current pediatric CPR and first aid training were verified for Licensee. It was also discussed that assistants must obtain Preventative health and current pediatric CPR and first aid training. CPR expires 11/2026. Mandated Reporter Training certificate expires: 04/04/28.


Licensee understands the training must be completed once every two years, and training is accessible at https://mandatedreportertraining.com/california/
Continued on LIC 809-C...
NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Corina Beckby
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 09/09/2026
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.



LPA provided an Individual Sleeping Plan (LIC9227). LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA reminded Licensee that sleep logs must be maintained for all children under the age of 2 years.

LPA provided the main office number for the Sacramento South Regional Child Care office (916) 263-5744 for licensees to call and report injuries or unusual incidents within 24 hours of the incident and reviewed the form (LIC 624B) to follow up in writing within 7 days of the incident. LPA encouraged Licensee to visit the department website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes. LPA reminded Licensee to advise the department of any and all facility closures (vacations, holidays, and illness). LPA explained to Licensee that absences shall not exceed 20% of the facility’s monthly working hours.
LPA discussed and provided Never Shake A Baby Poster (PUB 273-A2) and Pamphlet PUB 271 (2/17). Licensee was reminded to notify LPA of any changes to her hours of operation. Licensee understands inspections will be conducted whether children are enrolled or not. LPA discussed new mandates
Continued on LIC 809-C...
NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Corina Beckby
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026
LIC809 (FAS) - (06/04)
Page: 4 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 09/09/2026
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process .

Exit interview conducted and report was reviewed with the licensee Maritza Gross Gaitan. During the exit interview, the Licensee Maritza Gross Gaitan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Licensee stated she understood and is aware of all the information that was discussed and reviewed. A notice of site visit was given and must remain posted for 30 days. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of five years for public review upon request. The Licensee's signature on this form acknowledges receipt of this form.

LPA informed Licensee, Maritza Gross Gaitan that this report dated 09/09/2026, documents nine (9) Type A citations that is an immediate Health and Safety, or Personal Rights risk to persons in care. In addition, five (5) Type B citations was issued that is a potential Health and Safety, or Personal Rights risk to persons in care. A separate 809D is issued for each deficiency.

Upon receipt of a Type A deficiency Licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility.

Continued on LIC 809-C...

NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Corina Beckby
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026
LIC809 (FAS) - (06/04)
Page: 5 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 09/09/2026
NARRATIVE
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This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and Licensee will obtain a signed Acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An Exit interview was conducted, and the report was reviewed with Licensee, Maritza Gross Gaitan. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of five years for public review upon request. The Licensee's signature on this form acknowledges receipt of this form.

NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Corina Beckby
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026
LIC809 (FAS) - (06/04)
Page: 6 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in playground structure is not anchored and there's a swarm of wasps on the structure which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will ensure that playground is anchored down before children play on playground and swarn of swaps is removed before children access the playground area and submit proof to LPA by POC date.
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having poisons,cleaning detergents and compounds,sanitizer, accessible to children in care in the home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will ensure all poisons,cleaning detergents and compounds,sanitizer are stored away and maintained inaccessible for all children in care and submit proof to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 7 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(a)(4)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (4) Mattresses shall be made specifically for the size crib or play yard in which they are placed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having extra padding in pack n plays which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will remove and not use any extra padding in pack n plays and send proof to LPA by POC date. Licensee and assistant will watch department video regarding safe sleep, submit a summary of video and statement that they understand and will comply with all safe sleep regulations.
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in infants using blankets while napping which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will remove all loose articles from all cribs and not use blankets while infants are napping. Licensee and assistant will watch department video regarding safe sleep, submit a summary of video and statement that they understand and will comply with all safe sleep regulations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 8 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in ensuring no objects hanging above or attached to the side of the crib, LPA observed blankets were hanging on top of the pack n play, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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LPA will ensure that no objects hanging above or attached to the side of the crib and Licensee and assistant will watch department video regarding safe sleep, submit a summary of video and statement that they understand and will comply with all safe sleep regulations.
Type A
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having sleeping infant in a swing with blanket which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will ensure to move infant to a crib or play yard as soon as possible before infant falls asleep. Licensee and assistant will watch department video regarding safe sleep, submit a summary of video and statement that they understand and will comply with all safe sleep regulations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 9 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above in ensuring adult assistant has a criminal record clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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Licensee will ensure that adult assistant has a criminal record clearance before returning to work. Licensee will submit proof to cleared criminal record clearance to LPA.
Type A
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in
maintianing documentation of 15 min checks for all infants in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
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2
3
4
Licensee will submit 15 min checks for all infants in care to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 10 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(4)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in adult assistant grabbing child by the arm and forcing child to sit on seat during snack time,which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2026
Plan of Correction
1
2
3
4
Licensee and assistant will watch CDSS personal rights video and will submit statement submit a summary of video and statement that they understand and will comply with all personal rights for children in care to LPA by POC date..
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 11 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in licensee and adult assistant present did not have immunization records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2026
Plan of Correction
1
2
3
4
Licensee will ensure that licensee and adult assistant have records of immunizations of file and submit proof to LPA by POC date.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 7 out 7 children files did not have immunizations on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2026
Plan of Correction
1
2
3
4
Licensee will ensure to udpate all children immunizations on file and submit proof to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 12 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 04:30 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in maintianing a current facility roster on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2026
Plan of Correction
1
2
3
4
Licensee will ensure to maintain a current facility roster on file and submit proof to LPA by POC date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 13 of 16
Document Has Been Signed on 09/09/2026 06:04 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/09/2026 at 05:58 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review the licensee did not comply with the section cited above in ensuring fire drill are conducted and documented which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2026
Plan of Correction
1
2
3
4
Licensee will ensure to conduct and document fire drills with all chidlren in care and submit proof to LPA by POC date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
Page: 16 of 16