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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415470
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:47:00 PM

Document Has Been Signed on 07/27/2021 03:47 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ORTIZ, MARIAFACILITY NUMBER:
444415470
ADMINISTRATOR:ORITZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-7712
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Maria OrtizTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced one year required inspection to the home today. LPA met with Maria Ortiz, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Armando (present), her adult children Alejandro (present), Maria and Jeanette, and her son in law Eder. Present in today's inspection were six children in care included two infants two preschool age and one school age. Licensee's certification for CPR and First Aid are current and will expire on 8/08/2022
LPA toured the indoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed the Fire/Disaster drill log during today's visit. Last fire drill was documented on 6/10/21. LPA reviewed 4 children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. Licensee has a working telephone (landline) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed the home has central A/C and heating. Off limit areas in the home are the three bedrooms, one bathroom, and the attached garage. The home washing and dryer area is also located in the garage. There are no stairs in the home.
LPA observed a fully charged 3A40BC fire extinguisher last serviced on 2/19/21, working smoke and carbon monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed IMS with the Licensee. Licensee has in file immunization records for pertussis, measles, and flu vaccines for herself and for her helper according with the SB792.
A review of staff records on 7/13/2021 indicates that all adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Report dated 7/27/21 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ORTIZ, MARIA
FACILITY NUMBER: 444415470
VISIT DATE: 07/27/2021
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Report dated 7/27/21 continues from page 1.

LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time, the ratio (age of the children) must be observed and a qualified assistant must be present. The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.

LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee.
Licensee and her spouse and helper have completed on 2/4/2020 the "Mandated Reporter" training that all Licensees and adults in contact with children are required to take in accordance with the AB1207. Licensee understands that all the adults in contact with children are required to take the training, and the training must be renewed every two years.

LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.
No deficiencies were cited. Licensee's rights was printed and given to Licensee. Exit interview and inspection was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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