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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700023
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:19:26 PM

Document Has Been Signed on 01/05/2022 12:19 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CORTEZ FAMILY CHILD CAREFACILITY NUMBER:
197700023
ADMINISTRATOR:CORTEZ, MIROSLAVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 216-0923
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Miroslava Cortez Cortez and Leticia CortezTIME COMPLETED:
12:40 PM
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Licensing Program Analysts (LPAs) Isabel Ortega and Monique Ayala conducted an unannounced annual random inspection. The LPAs met with licensee who guided the LPAs on a tour of the facility. Upon entry to the facility the LPAs observed 10 children in care with licensee Miroslava. Licensee Leticia Cortez arrived shortly after.

This is a two-story family home. There is a living room, kitchen, dining room, four bedrooms, two restrooms, Family room(utilized for the child care), a shed and an attached garage. The off-limits areas are one restroom, three bedrooms, the kitchen, attached garage. Main care is provided in the family room referred to as the Child Care area. The children use the bathroom located to the right down the hall. The kitchen is barricaded with a child safety gate to prevent children from accessing the kitchen. The laundry room off limits and maintained locked.

The day care home provides breakfast, morning snack, lunch, afternoon snack and dinner as needed. The operating child care hours are Monday through Friday from 6:30 a.m. to 5:30 p.m.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/05/2022 12:19 PM - It Cannot Be Edited


Created By: Isabel Ortega On 01/05/2022 at 11:04 AM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700023

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in ratio regulations, 10 children to 1 staff. Which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2022
Plan of Correction
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Licensee will schedule medical appointments outside of day care hours.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Carissa Bell
LICENSING EVALUATOR NAME:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022


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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700023
VISIT DATE: 01/05/2022
NARRATIVE
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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The knives are kept in the kitchen in a drawer a child safety gate was observed. All cleaning supplies and chemicals are stored in the laundry room inaccessible to children (child safety knob observed).

There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons.

The First Aid kit was observed and complete. The required fire extinguisher (2A10BC), smoke and carbon monoxide detectors were found to be in operable condition (tested 10:00 a.m.). Fire and disaster drills are conducted every six-month, last emergency drill was conducted in November, 202 at 11:00am. Licensee's Pediatric CPR and First Aid certificate is current expires 4/2023.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)

The licensee provided proof of immunization against pertussis (TDAP), measles (MMR), and influenza.



The LPA observed a current child roster. Child files were found to be complete.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700023
VISIT DATE: 01/05/2022
NARRATIVE
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The backyard is gated all around. The outdoor play area is free from debris.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPAs also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than #1 week.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to the CCL web site for additional information and PINS.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700023
VISIT DATE: 01/05/2022
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm Child Care Advocates:

To sign up for our Quarterly Updates please email the Child Care Advocates at


chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was not found to be in compliance per Title 22 regulations, onedeficiency will be cited a Tpye B Deficiency today. An exit interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee. Appeal rights were provided and discussed with licensee, Leticia Cortez.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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