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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136609214
Report Date: 05/17/2023
Date Signed: 05/17/2023 07:18:44 PM

Document Has Been Signed on 05/17/2023 07:18 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ORTIZ, ALEJANDRINA FAMILY CHILD CAREFACILITY NUMBER:
136609214
ADMINISTRATOR:ORTIZ, ALEJANDRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 337-8494
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
05/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Alejandrina OrtizTIME COMPLETED:
05:00 PM
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On 5/17/23 at 2:25pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced Plan of Correction (POC) inspection. The purpose of this inspection is to ensure citations issued during an annual on 5/8/23 were corrected. Upon arrival, LPA met with Licensee, Alejandrina Ortiz and was led on a tour of the facility. There were seven (7) children, three (3) of whom were infants. Also present was licensee’s husband, David Ortiz and helper, Claudia Jiminez. Translation was provided via Language Link #16355.

At 2:35pm LPA observed Child 1 (C1) and Child 2 (C2) in play yards with blankets; see LIC809D for repeat violation cited and civil penalty assessed. Licensee has not documented 15 minute checks for sleeping infants; see LIC809D for repeat violation cited and civil penalty assessed.

LPA, Martha Malane informed licensee, Alejandrina Ortiz that this report dated 5/17/23 documents one (1)Type A citatioTyn which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.
Also, LPA, Martha Malane informed the licensee, Alejandrina Ortiz to provide a copy of this licensing report dated 5/17/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Deficiencies cited on 5/8/23 were corrected and cleared as follows: Per observation and interview, there were no infants sleeping in car seats. Play yards had tight fitting sheets on mattresses, pacifiers did not have anything attached, C1 had an emergency card on file and helper had immunization records on file.

Exit interview conducted with Licensee, Alejandrina Ortiz. LIC9098 POC form provided to licensee. Notice of Site Visit shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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Document Has Been Signed on 05/17/2023 07:18 PM - It Cannot Be Edited


Created By: Martha Malane On 05/17/2023 at 04:03 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ORTIZ, ALEJANDRINA FAMILY CHILD CARE
FACILITY NUMBER: 136609214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2023
Section Cited
CCR
102425(b)(1)(A)

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(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

This requirement is not met as evidenced by:
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Licensee removed the blankets and stated she will not have blankets in the play yard with a sleeping infant. Licensee stated she will utilize sleep sacks for infants if needed.
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Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of three (3) sleeping infants had blankets in their play yard which poses/posed a potential health, safety or personal rights risk to persons 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:Tulam Vu
LICENSING EVALUATOR NAME:Martha Malane
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2023 07:18 PM - It Cannot Be Edited


Created By: Martha Malane On 05/17/2023 at 04:10 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ORTIZ, ALEJANDRINA FAMILY CHILD CARE
FACILITY NUMBER: 136609214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/19/2023
Section Cited
CCR
102425(j)(1)

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The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
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LPA provided licensee with a sample sleep log and safe sleep regulations. Licensee stated she will utilize a sleep log and document every 15 minute checks for all sleeping infants. Licensee will submit completed logs to the SDRO by 5/19/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in three (3) out of three (3) infants were not physically chect every 15 minutes which poses an immediate health, safety or personal rights risk to persons 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:Tulam Vu
LICENSING EVALUATOR NAME:Martha Malane
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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