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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416020
Report Date: 04/21/2023
Date Signed: 04/21/2023 01:23:15 PM

Document Has Been Signed on 04/21/2023 01:23 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: 2CENSUS: 2DATE:
04/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Lucia OrtizTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced Case Management inspection to the home today with the purpose of: Increase the capacity to the license. LPA met with Lucia Ortiz, Licensee. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. Licensee stated that herself, her partner Jose Luis, and her daughter Vanessa are the adults residing in the home. Also in the home resides licensee's 17 years old minor child. Present during today's inspection LPA observed two children, one is an infant the other is a preschool age. Licensee's certification for CPR and First Aid are current and will expire on 3/23/25.
LPA toured the indoor and outdoor areas of the home during today's inspection. Last fire drill was documented on 12/05/22. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is located in a complex of single homes townhouse style. The home has an small left side fenced yard which licensee uses as playground. The home has and small back yard and it is fenced and off limits. LPA observed the home has a barricaded fireplace. Off limit areas in the home are the second floor and the attached garage. The home has a washing and dryer area located on the second floor. LPA observed there are barricaded stairs inside the home.
LPA observed a fully charged, brand new 3A40BC fire extinguisher. LPA observed there are not bodies of water or wall heaters in the home. LPA observed the home has at least one combo smoke and carbon monoxide detector. 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. Licensee has renewed the "Mandated Reporter" training on 4/12/23. Licensee understands that all the adults in contact with children are required to take the training, and renew it every two years. A review of staff records on 4/11/23 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The home has received a fire clearance by the Office of the Fire Marshall in Watsonville California on 4/05/23.
No deficiencies were cited today.
Exit interview conducted and report was reviewed with the licensee Lucia Ortiz

A notice of site visit was given and must remain posted for 30 days.

Licensee was advised that a Large Family Child Care Home licensee would 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: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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