304313550-6-13-2019-06-CC-LBAS-BD4UTW-20190613155237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313550
Report Date: 06/13/2019
Date Signed: 06/13/2019 03:52:43 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:	HURTADO, MARIA DEL CARMEN		FACILITY NUMBER:	304313550
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 8	DATE:	06/13/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Licensee Maria Del Carmen Hurtado		TIME COMPLETED:	04:15 PM

NARRATIVE

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An unannounced case management inspection was conducted at the facility by Licensing Program Analyst’s (LPA) Barajas and LPA Corral on today’s date for an increase in capacity. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection the home and grounds were toured, and the licensee was operating within the licensed capacity. The hours of operation are 6a.m. to 6p.m, Monday through Friday. This inspection is being conducted in response to the licensee's request for an increase in capacity to 14. A fire inspection was conducted on 06/04/2019 by Inspector Bryan Healey ID# 30090, from Orange County Fire Authority CPR/Prevention Field Services in Irvine. An approved fire clearance was received by the Licensing office on 06/07/2019, via email. There was 1 infant, and 7 school age children in care. Licensee 17-year-old grandson was present during the inspection providing assistance, and licensee was reminded he cannot be left alone to care for children. The floor plan was verified. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home. Licensee understands children are not to use the garage or off limit rooms and areas for child care and are inaccessible by baby gates and door knobs/door locks. LPA Barajas verified assistant Ruth Marroquin is fingerprint cleared, has all required immunization's, CPR/First Aide from Heart Saver Pediatric First Aid CPR AED with expiration date 02/2021, LIC 9052, LIC 508 Criminal Record Statement, and Mandated Reporter Training completed on 02/19/2019. Licensee is approved to operate as a large family childcare home as of today.

There were no Title 22 deficiencies observed during today's inspection. LPA requested Licensee Maria Maria Hurtado to update a new LIC 279 with new hours and day's of operation and submit to office.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor Barajas	TELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

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: HURTADO, MARIA DEL CARMEN	FACILITY NUMBER: 304313550
	VISIT DATE: 06/13/2019

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Exit interview was conducted, and report was reviewed and discussed in Spanish. Notice of Site Visit was posted during the visit. The licensee 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 per day. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report. The licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.

End of Report

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor Barajas	TELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

LIC809 (FAS) - (06/04)

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