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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002798
Report Date: 11/22/2019
Date Signed: 11/22/2019 11:06:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ORDONEZ, JANIREFACILITY NUMBER:
414002798
ADMINISTRATOR:ORDONEZ, JANIREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 921-7253
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 12DATE:
11/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Licensee, Janire Ordonez TIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA), Luis J. Gomez met with licensee Janire Ordonez. LPA explained the purpose of the inspection and for an unannounced annual inspection. Present in the facility is licensee and 2 helpers caring for 12 children (2 Infants 9 Preschool age). Licensee is within capacity limits of the large license on this day. Licensee’s home is a 3 - bedroom, 1- bathroom 1- story house. Hours of Operation are: Mon- Fri: 8:00am- 5:00pm. Daycare areas: Living room, Bedroom #1, Bedroom #2 (Napping only) and Backyard. Off Limit areas are: Kitchen (Pass Though only), Bedroom #3 (Master bedroom), Hallway, Studio and Laundry Room.

At 8:45am on November 22, 2019 LPA inspected the home for health and safety hazards with the licensee. Daycare area has a variety of age appropriate wooden toys, games and blocks for the children. Home is clean, with proper temperature and ventilation. Licensee has cots located in bedroom #1. Bathroom #1 is kept clean, in good repair, and maintained with adequate supplies. Licensee has installed child safety gates on all off-limits areas. There are several child size tables and chairs for activities. Licensee stated she prepares all daily snacks and meals. Per licensee, there are no guns or weapons in the home. All cleaning supplies, poisons and other chemicals are stored inaccessible to children. Home has a working telephone, a smoke detector, carbon monoxide detector, and a fully charged fire extinguisher located in the entry way.

Six children's and two personnel files were reviewed. The children files had all required emergency identification information. Facility roster was reviewed. Emergency drills are done at the facility with the last drill conducted on, 07/29/2019, and properly logged. Licensee’s CPR/ 1st aid certification is current expiring: 02/2020. At 9:30am on November 22, 2019, LPA observed facility helper, without the proper criminal record clearances /or association on file.
(Continuation on 809- C)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ORDONEZ, JANIRE
FACILITY NUMBER: 414002798
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2019
Section Cited

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102370(d)(1) Criminal Record Clearance. All individuals subject to criminal record review as specified in section 1596.871 prior to working residing or volunteering in a licensed home. shall obtain a California clearance or criminal record exemption as required by the department. This requirement is not met as evidenced by.
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Based on observations and a file review, LPA Gomez confirmed facility helper is not does not have the proper criminal record clearances on file. This is an immediate health and safety risk to children in care.
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Licensee will submit proof of correction to LPA Gomez via email.

Civil penalty of $100 was assessed during today's inspection.


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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ORDONEZ, JANIRE
FACILITY NUMBER: 414002798
VISIT DATE: 11/22/2019
NARRATIVE
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(Page 2)
Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time. 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,
· Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

· Licensee was provided "Effects of Lead Exposure" information



Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. A plan of correction was developed with the licensee and exit interview was conducted with, Janire Ordonez and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
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