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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409187
Report Date: 08/23/2021
Date Signed: 08/23/2021 03:45:12 PM

Document Has Been Signed on 08/23/2021 03:45 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ORELLANA, MARITZAFACILITY NUMBER:
073409187
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Maritza OrellanaTIME COMPLETED:
04:00 PM
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On 08/23/2021 at 1:45 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an announced Re-location Inspection at Maritza Orellana home and met with Applicant, Maritza Orellana who has applied for a Small Child Care Home with a capacity of 8 children. The home was toured to conduct a Health and Safety Inspection. The Child Care home plans to operate Monday-Friday from 6am-5pm and Saturdays 8am-3pm. Living in the home is applicant and her 2 children ages 13 and 17.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

Applicant completed the 16-hour Preventative Health training which includes EMSA approved CPR and first aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, opted out for the current flu season and Tuberculosis (TB) clearance. Applicant has Criminal Record statement and Child abuse Index Clearance. Applicant owns the home and has submitted proof of ownership to CCLD. LPA reminded Applicant that when care for more than six and up to eight is provided, Applicant must notify parents. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents that she does not carry a day care insurance. Applicant has a working telephone in the home.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ORELLANA, MARITZA
FACILITY NUMBER: 073409187
VISIT DATE: 08/23/2021
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INDOOR SPACE: At 2:00 PM LPA toured the indoor space of the home. The home consists of living room, Daycare room, kitchen, backyard, garage, 4 Rooms and 2 bathrooms. The home is in compliance with Title 22 Regulations at this time.

IN-USE AREAS: Living room, Daycare room, kitchen, bathroom 1 and backyard

OFF-LIMIT AREAS: Room 1, Room 2, Room 3, Room 4, bathroom 2 and garage. Applicant has a latch at the top of the garage door where Room 3 is located making it inaccessible to children.

OUTDOOR SPACE: AT 2:20 PM LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed AC unit and a shed located in backyard. There are no water bodies in backyard, LPA discussed with applicant that there needs to be 100% supervision when children are playing with water.

LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector in Living room. Medicines, cleaning products, sharp objects are stored inaccessible to children in top level cabinets and garage. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare home. Applicant states that there are no pets or arms and ammunition stored in the home.

At 3:10 PM Discipline policy was discussed, and Applicant stated she will talk to the children and use "quiet time" as form of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children is located in the living room. Supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed.

LPA discussed Incidental Medical Services (IMS) policy. Applicant does plan on providing Incidental Medical Services (IMS). When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. LPA discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. AB 633 was discussed with Applicant. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ORELLANA, MARITZA
FACILITY NUMBER: 073409187
VISIT DATE: 08/23/2021
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LPA discussed with Applicant, Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.
Beginning January 1, 2019 AB2370 requires licensed family childcare homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. For Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important department information can be found on, http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates.
Licensee emailed childcareadvocatesprogram@dss.ca.gov for PINs
GUARDIAN system was discussed (PINs 20-20 / 21-01 / 21-02 CCLD) guardianloginsupport@dss.ca.gov

The following improvements to be completed prior to licensure of a small family childcare home by 08/30/21:
  1. Child proof locks on all 3 OFF-LIMIT Rooms
  2. Child proof gate around AC unit located in the backyard
  3. Medal poles taken out of the yard
  4. Lock on Shed in Backyard

LPA reviewed required postings and all forms and documents needed for starting the day care with Applicant. AT 3:30 PM Exit interview was conducted with Applicant and she signed the report acknowledging receipts of documents.
END OF REPORT
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC809 (FAS) - (06/04)
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