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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216138
Report Date: 09/27/2021
Date Signed: 09/27/2021 04:35:55 PM

Document Has Been Signed on 09/27/2021 04:35 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ORTEGA FAMILY CHILD CAREFACILITY NUMBER:
426216138
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Ashely OrtegaTIME COMPLETED:
04:40 PM
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On September 27, 2021 AT 4:05 pM, Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an unannounced case management inspection. Prior to entry to the home, a risk assessment was conducted for COIVD-19. The purpose of the inspection was to inspect the home at Licensee's request. Licensee Ashely Ortega submitted an updated Facility Sketch (LIC999) to include bedroom #1 which she states she wants to use as a napping area for day care. In addition to, the kitchen, living room, dining area, the designated bathroom and backyard.

The home was toured inside and outside. Inspection of the bedroom #1 revealed it is appropriate for day care. Licensee states she plans to put a play pen in bedroom #1 for napping purposes. Licensee stated the other two bedrooms have bedroom locks and will remain inaccessible to day care children.

Based on LPA's inspection the areas designated for day care children include the kitchen, living room, dining area, bedroom #1, the designated bathroom and backyard.


FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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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