304313164-10-11-2023-06-CC-ASIA-CWHP7S-20231011110426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313164
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:04:38 AM

Document Has Been Signed on 10/11/2023 11:04 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ORTEGA, JAZMIN & MARTINEZ, MIRTHA		FACILITY NUMBER:	304313164
ADMINISTRATOR:	ORTEGA,J.& MARTINEZ, M.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 589-1090
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	14	CENSUS: 4	DATE:	10/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mirtha Martinez & Jazmin Ortega		TIME COMPLETED:	11:30 AM

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	On 10/11/2023 9:00 AM, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 1 Year inspection assisted by Licensees Jazmin Ortega and Mirtha Martinez. Upon arrival, the licensee had three infants and 1 child in care. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions. INDOOR INSPECTION. The LPA inspected the indoor FCCH area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care with gates, including the stairs, and safety locks. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The licensee stated she keeps telephone service in the home when clients are in care. A record review shows that the last drill was documented on 8/23/23. The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. Clients nap on cots and infants in cribs/play yards. Per the licensee, beddings are stored individually and taken home to wash daily. The facility provides age-appropriate toys, play equipment, and materials for the clients served. The licensee provides breakfast, morning snack, lunch, afternoon snack, and dinner to the clients. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORTEGA, JAZMIN & MARTINEZ, MIRTHA	FACILITY NUMBER: 304313164
	VISIT DATE: 10/11/2023

NARRATIVE

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OUTDOOR INSPECTION: The backyard was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was maintained and free of any observable hazards. There are no bodies of water in the premises.
PERSONNEL RECORDS: The LPA reviewed licensees’ files. The licensee’s mandated reporter expires on 9/7/24 and the Pediatric CPR/First Aid certification expires on 5/13/25. Immunizations are in compliance.
CHILDRENS’ RECORDS: The licensee has a current roster of clients. Clients files were checked for compliance. An LIC 9227 Individual Infant Sleeping Plan and 15-minute check logs for 3 infants enrolled. The infant records were in compliance.

This facility provides Incidental Medical Services – IMS. LPA reviewed the storage of medication, equipment, and supplies and reviewed children’s, personnel, and administrative records. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child.

The licensee understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a [qualified] substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORTEGA, JAZMIN & MARTINEZ, MIRTHA	FACILITY NUMBER: 304313164
	VISIT DATE: 10/11/2023

NARRATIVE

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The licensee understands that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Child Care Advocate Program link: https://cdss.ca.gov/inforesources/child-care-licensing/child-care-advocates
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORTEGA, JAZMIN & MARTINEZ, MIRTHA	FACILITY NUMBER: 304313164
	VISIT DATE: 10/11/2023

NARRATIVE

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LPA reviewed the following safe sleep best practices with the licensee:
Always place infants 12 months and younger on their backs to sleep
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 loose bedding and soft items like blankets, pillows, and stuffed dolls out of the crib or play yard
Pacifiers may be used only if they do not have items attached to them and there is no recall
Avoid swaddling, overheating, and head covering in infants
The temperature of the room should be comfortable enough for a lightly clothed adult
Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
Conduct and document the 15-minute checks for all infants under 24 months
CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.

NO violations of the California Code of Regulations, Title 22, Division 12 were observed in the areas evaluated during today’s inspection.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The LPA conducted an exit interview and reviewed the report with the licensee. The Notice of Site Visit was posted. The licensee understands that the Notice of Site Visit shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager at the address listed above.
End of Report.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

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