304300460-3-24-2025-06-CC-VTRH-DF3Q4X-20250324115103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304300460
Report Date: 03/24/2025
Date Signed: 03/24/2025 11:51:13 AM

Document Has Been Signed on 03/24/2025 11:51 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	URBINA, JESSIE & IRELI		FACILITY NUMBER:	304300460
ADMINISTRATOR/ DIRECTOR:	URBINA, JESSIE & IRELI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 229-4847
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/24/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Urbina, Jessie and Ireli (Licensees)		TIME VISIT/ INSPECTION 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	Licensing Program Analyst (LPA) Vivian Trinh conducted a case management visit due to the licensee’s request to change the facility’s status from inactive to active. According to licensing records, the licensee has been on inactive status since 04/04/2022. LPA met with Urbina, Jessie and Ireli, the licensees, who guided LPA on a tour of the facility. There were no children present. Licensees 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. Currently, there are two (2) adults, including the licensee, and three (3) minor children living in the facility. Facility Day care hours are 6:00am-6:00pm, Monday through Friday. During today’s inspection, LPA and licensees toured the inside and outside areas of the facility sketch LIC 999 as accessible to childcare children. This is a single home, with 4 bedrooms and 2 1/2 bathrooms. Off-limits areas are made inaccessible by means latches. Licensee stated that OFF LIMITS areas include: All three (4) Bedrooms, Work Office, Garage, Back Yard, Both of the Side Yard, and Storages. The licensee acknowledged that children may never enter these off-limit areas INDOOR INSPECTION: The childcare area consists of the Living room, Family room, kitchen, and Front Yard. During inspection, the Children’s restrooms located in the hallway and inside the family room. Continued Page 2.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: URBINA, JESSIE & IRELI	FACILITY NUMBER: 304300460
	VISIT DATE: 03/24/2025

NARRATIVE

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OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well maintained and free of any observable hazards. Children will be able to have outside play in the enclosed front yard. There were no bodies of water in the facility at the time of inspection.
The children do not use the backyard. During the inspection, LPA observed 2 small dogs, and 1 big. LPA reviewed vaccine records for the 3 dogs.

Garage will not be used for day-care. The Licensees stated the garage will be off-limit.

Garage is to be utilized for limited activities, day-care children are not to napped or eat in the Garage.

There are working carbon monoxide, smoke detectors, that should be type 2A-10BC, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. Licensee stated there is no firearms dangerous weapons in the facility. LPA recommended that the ammunition shall be stored and locked separately from firearms.

There is a fireplace and an open-faced heater in the living room screened by a glass cover, which is barricaded by a cemented wall, and inaccessible to children in care. The home has age-appropriate toys for the ages served. During today’s inspection LPA observed. The Licensee is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone needs to remain the in the childcare at all times. Licensee stated they use the front yard for outdoor play.

The licensees Pediatric CPR/First Aid certification expired 9/2026. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles.

Continued Page 3.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: URBINA, JESSIE & IRELI	FACILITY NUMBER: 304300460
	VISIT DATE: 03/24/2025

NARRATIVE

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Proof of immunization against pertussis, measles for were reviewed and within compliance. During the record reviewed, Staff #2 The does not have proof of immunization against pertussis, and measles, and influenza. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training and to renew the training every two years. During staff file review licensee’s mandated reporter certificate expired 8/25/2021.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

The licensees understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.cdss.ca.gov/inforesources/community-care-licensing was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensees.

Continued Page 4.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: URBINA, JESSIE & IRELI	FACILITY NUMBER: 304300460
	VISIT DATE: 03/24/2025

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA discussed Assembly Bill 2866 regarding in-ground swimming pool safety requirement and provided licensee PIN 25-01-CCP Chaptered Legislation Affecting Childcare Facilities.

Licensee was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

In the areas that were evaluated, NO deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

In areas that were evaluated, facility was not incompliance with Title 22, Licensee will submit Staff 2 Immunization, including T/B test record before April 11, 2025, and Mandated Reporter Training for staff 1 and staff 2.

Exit interview conducted and report was reviewed with the licensee Urbina, Ireli. A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the licensee, Urbina, Ireli, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

End of the Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC809 (FAS) - (06/04)

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