Alvarez Castillo, Lorena

102421(a)(1) · The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child.

Licensee shall submit to Licensee Program a copy of the current and complete childrens enrollment forms by the POC date on or before 8/5/2025. Licensee was unable to find C15 file, which poses a potential health and safety risk to persons in care. Susy Cervantes NAME OF LICENSING PROGRAM MANAGER: Martha Jimenez-Villanueva NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

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102416(a)(2) · The licensee shall provide each employee ...of the Notice of Employee Rights (LIC 9052 (4/88)...(2) A copy of the signed notice form shall be retained in the employee's personnel record. This requeriment was not met as evidency by; Licensee shall submit to Licensee Program a copy of the two staff completed and signed a Notice of Employee Righst LIC 9052 by the POC date on or before 8/5/2025. LPA reviewed staff files. two staff missing LIC 9052 on file. This poses an immediate risk to the health, safety, and personal rights of the children in care. Susy Cervantes NAME OF LICENSING PROGRAM MANAGER Martha Jimenez-Villanueva NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 07/22/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

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102423(a)(4) · Each child receiving services from a FCCH shall have certain rights...To be free from corporal or unusaul punishment, infliction of pain...

Licensee will review regulation and submit a written statement of her understanding of the regulation and how she will prevent this from happening again by end of business day on 07/23/2025. Based on interviews, file reviews, observations and evidence gathered, which were conducted, the Department concludes that a child in care was hit in the home. This poses an immediate risk to the health, safety, and personal rights of the children in care.

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102421(a)(1) · The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child. Licensee shall submit to Licensee Program a copy of the current and complete childrens enrollment forms by the POC date on or before 7/24/24 Based on insepection the licensees did not comply with the section mentioned above. Licensee was unable to present child records for (ch1). Which poses a potential health and safety risk to persons in care. SUPERVISOR'S NAME Gladys Kuizon

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