073409187-8-18-2023-02-CC-CWAS-CUTPXP-20230818114240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409187
Report Date: 08/18/2023
Date Signed: 08/18/2023 11:42:47 AM

Document Has Been Signed on 08/18/2023 11:42 AM - 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, MARITZA		FACILITY NUMBER:	073409187
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	08/18/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Maritza Orellana		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/18/2023 at 9:15 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced case management – licensee initiated for Maritza Orellana's small family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 7 children in care (2 infants and 5 preschool aged children) and 8 children enrolled. Family members residing in the home are licensee, licensee husband and licensee's mother and father. Licensee and all adults in the home have Criminal Record Clearance. Facility hours of operations are Monday - Friday from 6:00 AM to 5:30 PM and Saturday 8:00 AM-3:00 PM. Licensee completed her Pediatric CPR/First Aid which expires 03/2024 and Mandated Reporter certificate which expires 10/2024. Licensee has documentation maintained for Measles, Pertussis Immunization's, and Influenza Opt-Out statement for the current flu season. Licensee could not provide the documentation for the Tuberculosis (TB) test. Licensee stated she will submit proof to licensing. The licensee provided proof of control of property. There is a working telephone in the home. Fire clearance request was approved on 07/31/2023 by Contra Costa County Fire Protection District. This is a one story home which consists of 4 bedrooms, 2 bathrooms, kitchen/dining area, living room, daycare room, attached garage that is converted into laundry room and storage, backyard with shed on left side are Room, Kitchen/Dining Area, Bathroom 1 and backyard. Licensee utilizes the daycare room as the main room for her day care. (Daycare room is in the rear room of the home.) Areas off limits include: 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 and laundry room is located making it inaccessible to children, The LPA toured all areas used by children during this visit. *CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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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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: 08/18/2023

NARRATIVE

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*PAGE 2*
Per licensee, there are no firearm in the home. LPA observed a fireplace in the living room which has been made inaccessible to children to care. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. LPA reminded that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes.

OUTDOOR SPACE: LPA toured the outdoor area and observed a fully fenced and safe backyard for children in care. LPA observed age appropriate toys for children to play with. Licensee stated she is updating her backyard, specifically adding a outdoor shed on the left side of the backyard and updated the floor in the backyard. Licensee stated she is currently not using the backyard for outdoor activity until construction of the backyard is completed. Licensee stated they should complete the construction in two weeks.

LPA discussed and reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that licensee has to be present in the day care for 80% of the operation hours. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.
For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

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.

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. *CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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: 08/18/2023

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*PAGE 3*

Facility is recommended for increase of capacity, subject to submitted plan of correction. License will be pending a final file review.

Documents required to complete increase of capacity application:
1) Submit documents to licensing:
a) Statement Requiring to Report Child Abuse (LIC 9108)
b) Tuberculosis (TB) Test for Licensee (Maritza)
c) Add spouse to LIC 279 and update hours of operation
d) Maria (Aide) must complete Mandated Reporter training

All documents stated above must be submitted to licensing prior to completion of increase of capacity application.

During today's inspection, there were no violation observed.

Exit interview conducted and report was reviewed with the Maritza Orellana. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC809 (FAS) - (06/04)

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