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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243902523
Report Date: 05/23/2022
Date Signed: 05/23/2022 10:35:09 AM


Document Has Been Signed on 05/23/2022 10:35 AM - 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ORTIZ, JESSICA FAMILY CHILD CAREFACILITY NUMBER:
243902523
ADMINISTRATOR:ORTIZ, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 710-9360
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:14CENSUS: 1DATE:
05/23/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica Ortiz - LicenseeTIME COMPLETED:
11:00 AM
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On 05/23/2022 Licensing Program Analysts (LPAs) Joseph Pacheco and Priscilla Zamudio, conducted an unannounced case management legal inspection. LPAs met with Licensee, Jessica Ortiz. The purpose of the inspection was to confirm Licensee’s Adult Son, Gabriel Marcus Ortiz is not residing in the home or present with access to day care children. Licensee stated that Gabriel Marcus Ortiz is currently incarcerated in Merced County Jail. Notification letter of immediate exclusion for Gabriel Marcus Ortiz served on 5/3/22 was reviewed with Licensee. This letter informs Licensee that Gabriel Marcus Ortiz is excluded from being present in all facilities licensed by the Department. Licensee understands she is to ensure Gabriel Marcus Ortiz is excluded from having contact with day care children or being physically present at (any) facility. Licensee was reminded exclusion order remains in place, unless otherwise notified in writing by the Department. LPAs reminded Licensee that if Gabriel Marcus Ortiz were to arrive at the facility, she must immediately contact local law enforcement and inform the Department.

LPAs reviewed children’s files and observed signed copies from children’s authorized representatives acknowledging receipt of LIC 995B Family Child Care Home Addendum To Notification of Parent’s Rights (Regarding Removal/Exclusion).

Per California Code of Regulations Title 22, Division 12, Chapter 3, no deficiency is being cited today. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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