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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313284
Report Date: 10/18/2022
Date Signed: 10/18/2022 02:28:45 PM

Document Has Been Signed on 10/18/2022 02:28 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:AMBRIZ, VIRGINIAFACILITY NUMBER:
304313284
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee Ms. Ambriz, Virginia TIME COMPLETED:
02:45 PM
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A Case Management (Licensee initiated) inspection for a change in capacity was conducted at the facility by Licensing Program Analyst (LPA), Desai, Ketki. LPA observed licensee Ms.Ambriz, Virginia caring for 6 children between the ages of 14 months -4 years old. Licensee has been a care provider for a Small Family child care home since April 2018 qualifying her to be a Large Family child care provider.

Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date 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 4 adults and 2 minors including the licensee living in the facility.

Licensee stated, she is currently registered with Resource Foster Care agency and holds a Resource foster parent license.
Per Licensee, operation hours will be Monday to Friday, 6.00 AM to 6.00 PM, care and supervision shall be provided to children ages New born to 8 years of age (Infants to School age).

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of baby gates and baby locks. The childcare area consists of the enclosed patio room with a bathroom. Licensee stated the children's primary area is the childcare room (enclosed patio). Kitchen is open, all the sharp objects are placed on the top shelf in a clear box inside a closed cabinet other kitchen cabinets have a child safety stoppers installed making the open kitchen area safe, a wooden child gate is installed at the end of the kitchen, which remains closed during operating hours.

Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: AMBRIZ, VIRGINIA
FACILITY NUMBER: 304313284
VISIT DATE: 10/18/2022
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Off Limit areas: Five Bedrooms/ Living area/ TV room/ Kitchen and two bathrooms are designated as off limit area , all the doors have covered door knobs and they were observed to be locked on today's inspection. Kitchen is only used for entering and exiting the day care room.

Designated Day care area: Licensee stated the designated Day Care area converted patio room, one bathroom and backyard. All activities including Infant care is held in this room. Day care room has various educational and learning activities, including age appropriate furniture. Dining activities are also held in this area on the small table. The day care area is spacious with Educational toys and items for the children. Infant pay pens and changing table are arranged at the end of the room giving space to the older children.

Napping area has been set up with mats, linens & blankets are provided by the parent and sent home on a weekly basis. Children nap in these area. Day care area is safe and appropriate set up was observed. It is well lighted with proper ventilation and air flow. All infant needs are provided by the parent , a sleep log is maintained by the Licensee to record their sleeping time.

The designated bathroom is in the same room. Designated children’s bathroom was observed to be safe and free of hazardous items and bathroom was clean.

OUTDOOR PLAY AREA: Per Licensee, children use the back yard area, It is completely fenced with grass and concrete flooring, age appropriate toys with swing set was observed. It is safe for outdoor activities. Backyard is divided into two sections, there is a fencing gate in the middle and the pet dog remains on the other side.



Per Licensee there are No weapons or Firearms or Bodies of Water on the premises. Licensee has two big dogs they were in the backyard , behind the fenced gate.

Licensee does provides AM snack / Lunch and PM snacks to the enrolled children. Licensee is enrolled in the food program ( Comprehensive Child development services) If food is brought from home, this containers are labelled and stored in their individual cubbies.

(2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
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: AMBRIZ, VIRGINIA
FACILITY NUMBER: 304313284
VISIT DATE: 10/18/2022
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LPA verified there is a working telephone service (cellular service)

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials



LPA reviewed the following safe sleep best practices with Ms Ambriz, Virginia
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*Always place infants on their backs for sleeping
*Use only a tight-fitting sheet on the crib or play yard mattress
*Do not hang any items from the crib or above the crib
*Keep all items, including blankets, out of the crib or play yard
*Pacifiers may be used as long as 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 enough for an adult to wear a T-shirt and not be too hot or too cold

The licensee does have a current roster of children in care and the 3 records were reviewed on today's inspection, LPA reviewed the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee and the three assistants holds a valid Pediatric CPR/First Aid certification is valid through October 2024 and have also completed the required Mandated Reporter Child Abuse training on 10/2022.
Licensee also has conducted Emergency fire and earthquake drills, last drill conducted in September 2022.

The licensee understands she must be present in the facility, must ensure children in care are supervised at all times, and children are not to be left 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, immunization's, Pediatric CPR/First Aid, and mandated reporter training.

A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. (3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
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: AMBRIZ, VIRGINIA
FACILITY NUMBER: 304313284
VISIT DATE: 10/18/2022
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OTHER INFORMATION AND FORMS PROVIDED:
Capacity Handout for a Large Family Child Care Home was provided and LIC 9150 was reviewed with the Licensee ( Spanish handouts were provided).

Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance.

LPA discussed the following items with the Licensee Ms. Ambriz, Virginia during the Exit interview:

Criminal Record statement: Facility Representative Ms. Ambriz, Virginia was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep : LPA discussed the safe sleep regulations with Facility Licensee Ms.Ambriz, Virginia & discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Facility Representative Ms. Ambriz, Virginia 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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.



Review of records to be maintained : LPA reviewed with Facility Representative the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LIC 311D was given to the Licensee at the time of the Exit interview. (4)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: AMBRIZ, VIRGINIA
FACILITY NUMBER: 304313284
VISIT DATE: 10/18/2022
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LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Subscribe to CCLD important information
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The facility was complying with Title 22 Regulations at the time of inspection

LPA discussed the ratio for the Large Family Child Care home with the Licensee: Large Family Child Care Home, and with an assistant provider, may provide care for more than 12 and up to 14 children when one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, and another child is at least six years old, and no more than three infants are in care.


On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

A license with the change in capacity for 14 children (Large Family Child care home) will be issued after final review, in the event additional requirements are needed, Licensee will be notified.


A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

A copy of this report and Appeal rights were presented to the Licensee.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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