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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406809
Report Date: 05/16/2019
Date Signed: 05/16/2019 02:27:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ORUCUTA, JUANAFACILITY NUMBER:
073406809
ADMINISTRATOR:ORUCUTA, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 898-1476
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 11DATE:
05/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Juana OrucutaTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual site inspection for this facility on 05/16/19 at 1145. LPA met with licensee, Juana Orucuta, and toured all areas utilized by children in care with licensee. Also present was German Arellano and there were eleven children in care consisting of six infants and five preschool age children. The facility is over capacity for infants. Per licensee, two of the infant children present, C9 and C10, were temporary "drop-ins" for "a couple of hours." At approximately 12:00 PM, C9 and C10, were picked up from the facility by their parent per licensee. Children in care remaining at the facility was four infants and Per licensee there are no firearms present or stored on the premises. The areas on limits for children in care are the main day care rooms at the entry to the home and the hallway bathroom. All other areas of the home are off limits to children in care and made inaccessible to children in care by closed doors and visual supervision. The facility has available heating and ventilation for temperature management. There are age appropriate furnishings, toys and equipment, including Pac and Play portable infant sleeping equipment, which appears to be free of broken/sharp pieces. LPA reviewed with licensee infant safe sleep guidelines and reminded licensee that bassinet type equipment is not to be used for infant sleep. The facility has multiple working smoke detectors and a pull fire alarm. At approximately 12:20 PM LPA observed that licensee was not able to locate a working carbon monoxide detector present at this facility. LPA also observed that the fire extinguisher present had its needle/guage in the red area meaning it was not fully charged and had not been serviced since 03/2018 per the attached tag. There were no hazardous items/toxins observed to be accessible to children in care and the facility utilizes child safety devices to make cleaning supplies/toxins inaccessible. There is an outdoor yard/play area which is fully fenced and available to children in care. The outdoor areas on either side of the home are off limits to children in care and are to be made inaccessible by child safety gating at all times that children are outside. There is a trampoline present which is not used by children in care per licensee and is to remain netted and fastened closed to ensure that children in care do not use the trampoline. There is no high climbing equipment or swings present. The facility has one pet (dog). LPA reviewed the facility, children's and personnel records including children's emergency ID forms, consent for medical treatment forms and
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SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ORUCUTA, JUANA
FACILITY NUMBER: 073406809
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
102417(g)(1)
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102417(g)(1) Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This facility was not in compliance with this regulation as evidenced by LPA's observation that the fire extinguisher present
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The licensee agrees to provide proof of the presence of a fully charged fire extinguisher meeting fire marshall standards at this facility by the POC date. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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at this facility was not appropriately charged and had not been serviced since 03/18 posing a potential risk to the health and safety of children in care.
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Type B
05/31/2019
Section Cited
HSC
1597.46(e)
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 1597.46(e)A large family day care home shall have one or more functioning carbon monoxide detectors that meet the requirements of Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. This facility was not in compliance with this requirement as evidenced by LPA's observation that the facility did not have a carbon monoxide detector present.
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Licensee agrees to provide proof of the presence of a working carbon monoxide detector present at this facility by the POC date. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
05/31/2019
Section Cited
CCR
102421(b)
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102421(b) The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This facility was not in compliance with this requirement as evidenced by LPA's observation that there was no emergency Information forms for children C1, C7, C8, C11 posing a potential risk to the safety of the child.
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Licensee agrees to provide copies of the completed and current emergency information forms for children C1, C7, C8, C11 by the POC date. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ORUCUTA, JUANA
FACILITY NUMBER: 073406809
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2019
Section Cited
CCR
102416.5(d)(1)
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102416.5(d)(1) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:(1) Twelve
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Licensee agrees to ensure that the facililty adheres to the capacity as stated on the license including a maximum of four infants in care at the same time. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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children, no more than four of whom may be infants. This facility was not in compliance with this regulation as evidenced by the presence of six infants at the time of LPA's arrival at this facility posing an immediate risk to the health and safety of children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ORUCUTA, JUANA
FACILITY NUMBER: 073406809
VISIT DATE: 05/16/2019
NARRATIVE
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children's immunization records. At 1:10 PM, LPA observed that the facility did not have children's files available for children C1, C7, C8, and C11. All required postings are present. Licensee is encouraged to visit www.ccld.ca.gov for licensing forms and updates. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 Contact childcareadvocatesprogram@dss.ca.gov to sign up for quarterly updates. A copy of the Childcare Providers Guide to Safe Sleep was provided.

The attached Type A and Type B deficiencies were cited during this inspection. California Code of Regulations, Tittle 22 is being cited on the attached LIC 9099D for a Type A violation. A copy of AB 633 and Parent Notification Requirements was provided for licensee. This citation must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled in the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child’s file to be reviewed by licensing. LPA printed and provided a copy of the appeal rights.

The notice of site visit was provided and is to remain posted at this facility for 30 days from today's date. A copy of this report is to remain available in the facility file for a period of three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4