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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020807
Report Date: 09/02/2021
Date Signed: 09/02/2021 02:56:24 PM

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:
198020807
ADMINISTRATOR:ORTIZ, MARYCRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 437-3099
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:14CENSUS: 0DATE:
09/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marycruz OrtizTIME COMPLETED:
03:10 PM
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This was an announced pre-licensing inspection conducted by Licensing Program Analyst (LPA) Crystal Green. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Applicant, Marycruz Ortiz, is requesting a large Family Child Care License. Also present during this inspection was Maria Morales, licensee for the existing facility #198000487.

LPA confirmed with applicant those residing in the home consists of herself, 4 adults and 1 minor child. Per applicant childcare services will be offered from Monday to Sunday from 6 am to 5am (23 hours). Ages to care for will be from 0- 14 years old.

At 1:30 p.m., LPA was toured through the interior of the home. This is a one- story home which consists of 3 bedrooms, 2 bathrooms, dining room, living room, kitchen, and front yard (fenced). All areas identified on the facility sketch were inspected. Areas that are accessible to daycare children are the living room, dining room, 1 bedroom, 1 bathroom, and front yard (fenced). Based on the Facility Sketch submitted, areas off-limits to children and parents are 2 bedrooms, 1 bathroom, kitchen, and laundry room. There is a detached building in the back of the home where 2 tenants reside and have criminal record clearance.

**Rooms that are off-limits need to be made inaccessible during operating hours** The Applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA did not observe any hazards inside the home. LPA asked to be shown the electrical outlets in the areas used by the children and observed to be covered. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Applicant states that there are no poisons in the home. The Applicant was advised that any poisons must be locked with a key or combination lock. LPA also observed appropriate equipment, toys, and games for children.

Report Continues Page 1 of 4.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 198020807
VISIT DATE: 09/02/2021
NARRATIVE
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The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on the receipt of purchase dated 07/29/2021. There is a first aid kit located in the living room. There are smoke detectors throughout the home and a carbon monoxide detector located in the dining room area. At 1:35 p.m., LPA was toured through the exterior of the home. The front yard will be used for daycare outdoor play. LPA observed the front yard area to be fenced. There are age-appropriate toys and play equipment on site.

Per Applicant, there are 3 pet dogs that reside in the home, no weapons, no firearms or bodies of water on the premises. The applicant states that she will provide food for children in care. The applicant has completed the required Health and Safety Training, Nutrition Training, Lead Poisoning Prevention Training and Pediatric First Aid and CPR. The applicant has completed the required Mandated Reporter Training.

The following was discussed with the applicant:

-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalty will be assessed if not in compliance.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated with the facility license.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.

-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes, and/or if you move from your home.

-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)

Report Continues Page 2 of 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 2 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 198020807
VISIT DATE: 09/02/2021
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-Fire and safety drills must be performed every six months and documented for review by the Department.

-Smoking is prohibited in a family child care home.

-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines, and any other item that falls into that category are not permitted in the facility.

-All adults living and working in the home shall be made aware of the Department's right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation.

- Licensees shall reveal each facility license number in all advertisements, publications, or announcements with the intent to attract clients.

- Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are required to be posted.

Infant Care: Applicant states that she plans to care for infants. LPA advised the applicant to sleep infants where the infant can be directly supervised. LPA reviewed safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

Medication: 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Applicant she will not carry liability insurance or a bond in accordance with the standard established by the Family Child Care statute. Signed statements (LIC282) will be on children’s files. The law requires a Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

Report Continues Page 3 of 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 198020807
VISIT DATE: 09/02/2021
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At this time, the applicant is in compliance with California Code of Regulations Title 22. There is an approved fire clearance on file. LPA reviewed COVID-19 precautionary measures during this inspection. At this time, the applicant home meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations, and will be submitted for approval to be licensed as a Large Family Child Care Home.

Exit interview was conducted with Applicant Marycruz Ortiz.

Report Ends Page 4 of 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4