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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216138
Report Date: 12/16/2021
Date Signed: 12/16/2021 03:08:40 PM

Document Has Been Signed on 12/16/2021 03:08 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: 8CENSUS: 4DATE:
12/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Ashley OrtegaTIME COMPLETED:
03:15 PM
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On December 16, 2021 at 2:40PM, Licensing Program Analysts (LPAs) S. Mendoza-Ceja and D. Thompson conducted an unannounced case management inspection. 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 usage of the garage as an alternate play area. In addition to, the kitchen, living room, dining area, bedroom #1, and the designated bathroom and backyard.

The home was toured inside and outside. Inspection of the garage revealed it is appropriate for day care area; however, needs to be organized for 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, backyard, and the garage.

Prior to use of the garage, the licensee will need to submit picture of the garage appropriately organized for children to play.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
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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