334845179-10-7-2022-09-CC-ASHA-CJYSDM-20221007134722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845179
Report Date: 10/07/2022
Date Signed: 10/07/2022 01:47:29 PM

Document Has Been Signed on 10/07/2022 01:47 PM - 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	ORTIZ FAMILY CHILD CARE		FACILITY NUMBER:	334845179
ADMINISTRATOR:	ORTIZ,CHELSEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 845-6081
CITY:	BEAUMONT	STATE: CA	ZIP CODE:	92223
CAPACITY:	14	CENSUS: 10	DATE:	10/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Chelsey Ortiz		TIME COMPLETED:	01:00 PM

NARRATIVE

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On date and time listed, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility to conduct a required annual inspection. Present during the inspection were licensee, Chelsey Ortiz and licensee's spouse, Orlando Ortiz as well as 10 children in care. LPA toured the facility, inside and out. Records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday- Friday 6:30am-5:30pm

OFF-LIMIT AREAS INCLUDE: Garage, stairs, entire second floor and

· The facility is operating within the licensed capacity and appropriate ratios

· Appropriate supervision was provided during this inspection

· A working telephone is present and current number is on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were present and in working order during this inspection.

· Fireplace is not accessible by children.

· All hazardous items are inaccessible to children

· Toxins are locked in an off-limit area

· Weapons are not present at this time. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs are properly barricaded to prevent access to children in care.

· Verification of control of property on file

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 334845179
	VISIT DATE: 10/07/2022

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· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted

· Mandated Reporter Training for licensee and spouse completed on 03/28/22 and expire on 03/28/24

· Pediatric CPR and First Aid Card for licensee and spouse expire on 01/15/2024

· Health & Safety Certificate is completed and on file.

· No bodies of water at this time. Fence is at least five feet in height and in substantial compliance as per Title 22 regulation. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Clean, safe and age appropriate toys

· Current roster is on file

· Documentation of fire and disaster drills are also on file – Last drill conducted on: 09/13/2022

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Children’s records, licensee’s files and spouse's file are complete.

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 334845179
	VISIT DATE: 10/07/2022

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LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

-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

- Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200
-The Licensee, Chelsey Ortiz confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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

Exit interview conducted and report was reviewed with the licensee, Chelsey Ortiz.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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