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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014052
Report Date: 02/28/2024
Date Signed: 02/28/2024 05:03:33 PM


Document Has Been Signed on 02/28/2024 05:03 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ORTIZ FAMILY CHILD CAREFACILITY NUMBER:
198014052
ADMINISTRATOR:ORTIZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 728-8510
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY:14CENSUS: 10DATE:
02/28/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:16 PM
MET WITH:Ana Ortiz, LicenseeTIME COMPLETED:
05:20 PM
NARRATIVE
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On February 28, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Saul Valenzuela conducted an unannounced Case Management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with licensee, Ana Ortiz who guided LPAs on a tour of the facility. During the tour it was disclosed that Corrine Gomezcedillo resides in the converted garage and is not fingerprint cleared. Per licensee, Corrine does not provide care for children. Per licensee, Corrine was associated to another facility and was under the impression the fingerprints were still valid. LPAs observed 10 children in care. Also present in the home was licensee's spouse Martin Ortiz and licensee's adult son Jose Martin.

The purpose of the inspection is to conduct a health and wellness check for children in care. During interviews conducted it was disclosed that Martin Ortiz transports children to and from school. However, Martin has a criminal record exemption with an approval condition that he does not transport children. This poses an immediate health and safety risk to children in care.

The facility is being cited two Type A deficiency in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Article 01, Section 101223(a)(8) Definitions is being cited on the attached LIC 9099D. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. An immediate $500 civil penalty is being issued.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

An exit interview was conducted, and a copy of this report was provided to the licensee along with Appeal Rights.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
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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Document Has Been Signed on 02/28/2024 05:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 198014052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2024
Section Cited
CCR
102416(d)(1)

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Personnel Requirements: Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:
Obtain a California clearance or a criminal record exemption as required by law or Department regulations. This requirement
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Licensee will ensure that Corrine gets fingerprint cleared by POC date.
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was not met as evidence by: Based on record review and interview, Corrine Gomezcedillo lives at the facility but is not fingerprint cleared. Per licensee the uncleared adult does not provide care. This poses an immediate health and safety risk for children in care.
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Type A
02/28/2024
Section Cited
HSC1596.871(c)(C)(3)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Servies
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Per licensee, Martine will no longer transport children to and from school as of today 02/28/2024.
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to employment, residence, or initial presence in the facility... This requirement was not met as evidence by: Based on interviews conducted, Martin Ortiz has an approval condition for his exemption which is to not transport children. This poses an immediate health and safety risk to children in care.
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
LIC809 (FAS) - (06/04)
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