304311924-7-10-2019-06-CC-WPOT-BDXSY5-20190710141658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304311924
Report Date: 07/10/2019
Date Signed: 07/10/2019 02:17:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	OJEDA, ANTONIA		FACILITY NUMBER:	304311924
ADMINISTRATOR:	OJEDA, ANTONIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 770-2217
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	14	CENSUS: 8	DATE:	07/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Antonia Ojeda, Licensee		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 3 adults (including the licensee) and 1 minor child living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. There were 3 infants and 5 preschool age children being cared for the licensee and assistant, Tanya Samayoa. Also present upstairs in an off limits bedroom was the licensee's 13 year old son. Operating hours are 7:00 AM to 5:00 PM, Monday through Friday. The floor plan was verified. This is a two story home with 4 bedrooms and 3 bathrooms. The main day care areas are the living room, dining room and downstairs bedroom which is used for napping. Off limits areas are made inaccessible by means of baby gates and latches. The staircase, entire upstairs and garage is off limits. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There is an empty water fountain in the backyard. There is a fireplace in the living room screened by a fireplace cover and inaccessible to children in care. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisonous items are locked on the outdoor shed located on the left side yard. During today’s inspection LPA observed an infant in an item with a structure of a baby bouncer labeled "infant to toddler rocker". Bouncers and similar items are not permitted in a family child care home. Presence of these prohibited items poses a potential safety risk to children in care. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. LPA verified there is a working telephone service (landline). Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OJEDA, ANTONIA	FACILITY NUMBER: 304311924
	VISIT DATE: 07/10/2019

NARRATIVE

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The licensee understands she must present in the home and ensure that children that children in care are supervised at all times. The licensee understands children are never to be left in parked vehicles. The licensee states when temporarily absent from the home, she must arrange for a substitute adult to care for and supervise children in her absence. The substitute adult must have the required criminal record and child abuse index clearances, SB 792 immunization's, mandated reporter training, and valid pediatric first aid/CPR certifications.

The assistant's pediatric CPR/First Aid certification is current, which expires 07/20/2020. Children's records were reviewed for a completed children’s roster. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistant present today were reviewed and within compliance of SB 792.

Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. The licensee and assistant have proof of compliance as specified in A.B. 1207.

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

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A hard copy of the Spanish Spring 2019 Child Care Quarterly Update was provided to the licensee. A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee in Spanish. A hard copy of the Department of Social Services Lead Information Brochure was explained and provided to the licensee.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OJEDA, ANTONIA	FACILITY NUMBER: 304311924
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/25/2019 Section Cited CCR 102417(g)(10)	1 2 3 4 5 6 7	Operation of a Family Child Care Home 102417(g)(10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c). This requirement was not met as evidenced by:	1 2 3 4 5 6 7	LPA provided licensee with orientation publication with photos of items not permitted. The licensee stated she will remove the baby bouncer. Licensee will send written acknowledgment to our office stating the baby bouncer was removed and understands they are not permitted in a licensed facility by the due date of 07/25/2019.
	8 9 10 11 12 13 14	Based on LPA's observations: LPA observed an infant inside of an infant/toddler rocker which was observed to have the body structure of a baby bouncer. Baby bouncers/walkers are not permitted in child care facilities. This poses a potential safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OJEDA, ANTONIA	FACILITY NUMBER: 304311924
	VISIT DATE: 07/10/2019

NARRATIVE

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The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited today: Operation of a Family Child Care Home 102417(g)(10) (see LIC 809D).

Inspection, report review and exit interview was conducted in Spanish. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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