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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493097
Report Date: 03/26/2021
Date Signed: 03/26/2021 08:30:57 AM

Document Has Been Signed on 03/26/2021 08:30 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ORELLANA FAMILY CHILD CAREFACILITY NUMBER:
197493097
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
03/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:32 AM
MET WITH:Licensee Fabiola OrellanaTIME COMPLETED:
08:40 AM
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Due to Covid-19 mitigation measures, on 03/26/2021 at 07:32 a.m., Licensing Program Analyst (LPA) Antonio Almanza conducted an announced subsequent Increase in capacity Tele-visit via Zoom at ORELLANA FAMILY CHILD CARE and met with the Licensee FABIOLA ORELLANA. The purpose of the site visit is for changes to the off limit areas of the home prior to increase in capacity being granted. The applicant is applying for a Large Family Child Care License to operate Monday to Friday from 6:00 am to 7:00 pm and serve children ages 0 year to 13 years of age. There are 2 children in care during today’s visit. The single-story home is a 4 bedroom, 2 bathroom home with attached.

During todays visit the licensees room located in the back-left corner of the home was inspected for children to use during nap time. The room is accessed through a hallway located in the left corner of the living room. There is a bathroom in the hallway that will be off limits to children in care. The Licensee states the main care will be provided in the living room, and the bathroom that children in care will use is in the hallway next to the dining room. The off-limits areas of the home are as follows: the 3 teenage children bedrooms, kitchen, laundry room, garage and storage room located in the backyard. The off-limits areas of the home have child safety covers and gate making the areas inaccessible. Children in care will be going to the backyard through the hallway into the Licensees room and out the sliding door that leads to the backyard. The room was inspected for safety, comfort, cleanliness, ventilation, and inaccessibility to hazardous items that can pose a danger to children.

The following is needed prior to approval for Increase in Capacity:
1. Update Facility Sketch showing off limit’s areas of the home.
2. Dog immunization records (3 dogs)
3. Secure hallway door in order to make sure it does not cause injury to children when open.
4. Install Child Safety gate making kitchen inaccessible.

An Exit Interview was conducted, and a copy of this report and notice of site visit were emailed to the applicant. It has been explained that a reply to the email shall be considered a substitute for the hard-copy signature.
*** Report was explained to the Licensee in Spanish.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2021
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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