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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416020
Report Date: 10/13/2021
Date Signed: 10/13/2021 12:50:54 PM

Document Has Been Signed on 10/13/2021 12:50 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, LUCIAFACILITY NUMBER:
444416020
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Lucia OrtizTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced pre-licensing inspection to the home today. LPA met with Lucia Ortiz, applicant, and explained the nature of today's inspection to her. The adults that reside in the home are the applicant, her spouse Jose Luis, and her daughter Vanessa (present). Also in the home reside applicant's minor child 15 years old.
Days and hours of operation will be Monday to Friday from 6:00 AM to 6:00 PM. Applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training on 5/22/21. Applicant's pediatric CPR and First Aid certifications are current and will expire on 4/10/23. Applicant owns the home and a copy of the property title is in file. Applicant states does not have liability insurance for a family child care home (FCCH) and will use the Affidavit regarding liability insurance for Childcare (form LIC 282).
LPA toured the indoor and outdoor areas of the two story home during today's inspection. LPA observed there are not wall heaters in the home. Off limit areas inside the home: The second floor, and the attached garage. LPA observed applicant has a 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has at least one working carbon monoxide detector. Off limits outdoor areas are: Small back yard. LPA observed there are not bodies of water. Applicant's will use the left side yard as playground for the children in care. LPA observed the back and left side yard are fenced. Applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. LPA observed the home has a fireplace located in the living on limits area. Applicant stated the fireplace has been out of use for a long time and has been disconnected by the utility company. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. A review of staff records on 9/20/21 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant 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.
********************* Report dated 10/13/21 continues in page 2 ***************
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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, LUCIA
FACILITY NUMBER: 444416020
VISIT DATE: 10/13/2021
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Report dated 10/13/21 continues from page 1.
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.
Forms of discipline applicant will use: Communication with children and redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the applicant. Department website: www. ccld.ca.gov provided to applicant.
LPA discussed the requirements of AB 633 with the applicant. LPA also discussed "zero tolerance" related regulations with the applicant.
LPA observed proof of immunization for measles, pertussis and influenza are in file for applicant.
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. Applicant has completed the required "mandated reporter" training AB1207 on 5/03/21 and applicant understands the training is mandatory for all the adults in contact with children, and to be renewed every two years. LPA referred the applicant to the training website: www.manatedreporterca.com for additional information on the online training.

LPA advised the applicant of the new regulations on Safe sleep for infant children. and provided applicant with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.


LPA conducted an exit interview with the applicant and advised her that a small FCCH license will be approved pending on the following: 1) Approval from a manager of the Licensing Department.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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