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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311924
Report Date: 08/31/2021
Date Signed: 08/31/2021 02:41:57 PM

Document Has Been Signed on 08/31/2021 02:41 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:OJEDA, ANTONIAFACILITY NUMBER:
304311924
ADMINISTRATOR:OJEDA, ANTONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 770-2217
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Licensee - Antonia OjedaTIME COMPLETED:
03:00 PM
NARRATIVE
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An Annual Inspection was conducted at the facility by Licensing Program Analyst (LPA) Corral. LPA Corral reviewed COVID-19 Prescreening Questionnaire prior to entering the Facility. LPA Corral observed Licensee Antonia Ojeda and Assistant caring for 3 infants and 6 preschool children. Licensee was operating within the licensed capacity as specified on license. Due to COVID 19 guidelines, LPA observed staff wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary on 08/31/2021 indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 2 adults including the licensee and her husband and 1 minor child living in the facility. Facility Day care hours are 6am-5pm, Monday through Friday.

During today’s inspection, LPA Corral and licensee toured the inside and outside areas accessible to children in care. Off limits areas are the upstairs which is made inaccessible by means of child safety gate. The childcare area consist of the living room which is accessed through main entrance of the home. The children also have access to the kitchen and the dining room. The children walk through the kitchen to access the bathroom that is located down the hallway to the left. Licensee stated the children's primary area is the backyard. The home has a working carbon monoxide, smoke detector, and fire extinguishers which meets 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 in the garage and in the kitchen cabinet above 5 feet high made inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspection. There is a fireplace in the living room screened by a metal screen protector and is made inaccessible to children in care.



During today’s inspection LPA observed the children in the backyard playing where there is a playhouse with a slide, swings, and outdoor play equipment. Licensee and assistant were observed feeding the children then after play, children were napped. The home has age appropriate toys for the ages served.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Eileen Corral
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OJEDA, ANTONIA
FACILITY NUMBER: 304311924
VISIT DATE: 08/31/2021
NARRATIVE
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LPA verified there is a working telephone service via licensee's cell phone. LPA Corral verified outdoor play to be fenced, supervised and floors were observed to have cushioned material that could observe a fall. There were no poisons or other items observed which could pose a danger to children. There are no bodies of water on the premises.

The licensee does have a current roster of children in care. Licensee conducted a fire and disaster drill on 04/15/2021. LPA Corral conducted Record Review for the 2 infants ages 0-12 months present in care. LPA observed and reviewed LIC 9227 Individual Infant Sleeping Plan in both children’s files. Licensee did not have documentation for 1 of the 2 infants file regarding infant sleeping log which contained the child’s name, date and time of the 15 minute check. Licensee stated infant has not been in care since 08/19/2021 but Licensee did not maintain previous records for prior dates for Department review. Facility Record Review will be cited during today’s inspection.

The licensee’s CPR/First Aid certification expire on 09/2021. Licensee was reminded to schedule CPR/First Aid training. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee were reviewed and within compliance. 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. Licensee completed Mandated Reporter Training on 12/19/2018. Mandated reporting training certification was expired and was found to be out of compliance, mandated reporter training will also be cited during today’s inspection.

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

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Eileen Corral
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OJEDA, ANTONIA
FACILITY NUMBER: 304311924
VISIT DATE: 08/31/2021
NARRATIVE
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Licensee understands she must be present in the facility and must ensure children are supervised, also 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.ccld.ca.gov 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 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 licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” and a copy of PIN 20-06-CCP Social and Physical Distancing Guidance were also provided.

The following electronic links were also provided:
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with licensee the following safe sleep best practices:
- Always place infants on their backs for sleeping, only a tight-fitting sheet on the crib/play yard
- Do not hang items from the crib or above the crib, keep all items, including blankets out of the crib/play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The temperature of the room should be comfortable, not too hot or too cold

The following deficiencies were observed and are being cited during today's inspection.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Eileen Corral
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OJEDA, ANTONIA
FACILITY NUMBER: 304311924
VISIT DATE: 08/31/2021
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Infant Safe Sleep 102425(j)(2)(D)
The provider shall supervise infants while they are sleeping and adhere to the following requirements and the provider shall check and document the following: Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following, date, Infant’s name and
Time of each 15-minute check.

Health & Safety Code 1596.8662 (4)(b)(1)
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided… and shall complete renewal mandated reporter training every two years following the date on which he/she completed the initial mandated reporter training.

An exit interview was conducted with Licensee in Spanish. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

End of Report.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Eileen Corral
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/31/2021 02:41 PM - It Cannot Be Edited


Created By: Eileen Corral On 08/31/2021 at 01:58 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OJEDA, ANTONIA
FACILITY NUMBER: 304311924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
102425(j)(2)(D)

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Infant Safe Sleep
The provider shall supervise infants... and shall document... in the infant’s file and be available to the Department for review. Documentation shall include the following, date, infant’s name, and time of each 15-minute check. This was not meet as evidenced by:
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Licensee will provide documentation of infant's sleepig log which contains the date, infant’s name, and time of each 15-minute check by POC Due Date.
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Based on LPA Corral record review, Licensee did not have documentation available for 1 out of the 2 infants present in care. This poses a potential safety risk of the children in care.
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Type B
09/30/2021
Section Cited
HSC1596.8662(4)(b)(1)

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Availability of Information
On or before March 30, 2018, a person who is a licensed child care provider... shall complete the mandated reporter training and complete renewal mandated reporter training every two years following the date which he/she completed the initial mandated reporter training. This was not meet as evidenced by:
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Licensee will complete the renewal mandated reported training and provide LPA Corral with a copy of the certification by POC due date.
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Based on LPA Corral record review, Licensee completed her mandated reporter training on 12/19/2018 but did not complete the renewal mandated reported training. This poses a potential safety risk of the children 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:Rina Lopez
LICENSING EVALUATOR NAME:Eileen Corral
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


LIC809 (FAS) - (06/04)
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