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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312828
Report Date: 12/21/2020
Date Signed: 12/21/2020 11:57:52 AM

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:URQUIZA, KARINAFACILITY NUMBER:
304312828
ADMINISTRATOR:URQUIZA, KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 866-0079
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:14CENSUS: 0DATE:
12/21/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Karina Urquiza TIME COMPLETED:
11:15 AM
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Tele-Inspection
Licensing Program Analyst Barajas conducted an announced Tele visit via facetime for reopening of an inactive status home day care. LPA conducted an inspection of the facility on today’s date. Facility has fire clearance for a large license. The LPA toured the facility with the Licensee, Karina Urquiza. Present during today's inspection was Licensee husband Walter Urquiza, adult daughter Katelyn Urquiza, and two minor children who were in off limit bedrooms. A review of criminal clearance records on this date indicates adults who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 4 adult residents and 2 minor children living in the home. Licensee stated currently works Monday through Friday, 8a.m. to 5p.m. Licensee stated is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if any changes to notify the licensing office.
The facility is one story home, 4 bedrooms and 2 bathrooms. One of the bedrooms is detached and is being occupied by one of the residents, the room is equipped with a kitchenette, bathroom and has its own private entrance. Licensee has designated the following areas of the home as off limits and inaccessible to children are all bedrooms and garage. These areas have been made inaccessible by means of baby gates and door locks. Licensee has designated the living room to be used by the day care children. The children utilize the bathroom on the right next to the master bedroom. There are age appropriate toys available for children. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home. There is an open face heater in the living that has been properly screened and inaccessible to children. Cleaning solutions/chemicals, utensils, and sharp knives are all inaccessible. Licensee stated there are no Poisons/Hazardous items in the facility, and none were observed during today’s inspection. There are no bodies of water. Licensee stated there are no firearms or ammunition in the home or on the premises. Children will use the backyard as an outdoor play area. Backyard is fully fenced, and free of hazards. Licensee understands the home is always to be free from smoking.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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 2
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: URQUIZA, KARINA
FACILITY NUMBER: 304312828
VISIT DATE: 12/21/2020
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The licensee stated there are no weapons or firearms on the premises. Licensee was advised if will consider weapons in the future; they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

EMSA approved Pediatric CPR & Pediatric First Aid are current for the licensee and expires on 10/2021. Licensee completed the 8-hour Preventative Health Practices and Nutrition Course with Pediatric Plus. Licensee has Mandated Reporter Training completed.

Title 22 regulations, children files, the roster, reporting requirements, inactive status, the safe sleep policy for infants in childcare, emergency/disaster drills, SB 792, and fingerprint clearances were discussed. Web site addresses http://www.ccld.ca.gov and http://www.dss.cahwnet.gov were given to download forms and Title 22 regulations.

LPA reviewed with licensee the following safe sleep best practices:


· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

LPA reviewed recommended COVID 19 policies and procedures.
The facility complies for reopening of Large Family Child Care Home with Title 22 Regulations at the time of inspection.

Exit interview was conducted with Licensee Karina Urquiza via Tele-Inspection. Report was read to Licensee. A copy of the report along with Appeal Rights will be emailed to Licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available.

End of Report.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
LIC809 (FAS) - (06/04)
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