543903669-7-15-2019-04-CC-PESA-BE4STW-20190715141013

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543903669
Report Date: 07/15/2019
Date Signed: 07/15/2019 02:10:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	ORTIZ, DEBORAH FAMILY CHILD CARE		FACILITY NUMBER:	543903669
ADMINISTRATOR:	ORTIZ, DEBORAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 920-0860
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	14	CENSUS: 7	DATE:	07/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Deborah Ortiz,Licensee		TIME COMPLETED:	02:15 PM

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	(3) LPA Pete Espinoza made an unannounced Annual/Random inspection. LPA met with Deborah Ortiz,Licensee, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this facility. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked. Fireplace is inaccessible to children. Fire extinguishers and smoke/carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. The licensee is present in the home and ensures that children in care are supervised at all times. Children are not left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. The licensee and other personnel as specified have completed training on preventive health practices including pediatric CPR and First Aid; Expires: 03/16/2021. Business hours are Mon-Fri 6:00 AM to 6:00 PM. Licensee provided proof of required immunization (Pertussis/Measles/influenza and/or written declaration declining flu shot) AND required Mandated Reporter Training. 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. The following is cited per chapter 3, Title 22, Div. 12 of the CCR. Copy of appeal Rights left with licensee. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ORTIZ, DEBORAH FAMILY CHILD CARE	FACILITY NUMBER: 543903669
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Facility Administration - Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above; which poses a potential health, safety or personal rights risk to persons in care. Inspection Tool Notes: Licensee is unable to provide proof of completion of Mandated Reporter Training.
	POC Due Date: 07/29/2019
	Plan of Correction
1 2 3 4	Licensee will complete required Mandated Reporter Training by 07/29/2019. A return visit will be required.

Type B

Section Cited

HSC

1597.622(c)

Facility Administration - Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above; which poses a potential health, safety or personal rights risk to persons in care. Inspection Tool Notes: Licensee is unable to provide proof of Immunizations (measles/pertussis/Influenza).
	POC Due Date: 07/29/2019
	Plan of Correction
1 2 3 4	Licensee will provide proof of required immunizations (measles/pertussis/influenza by 07/29/2019. A return visit will be required

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC809 (FAS) - (06/04)

Page: 2 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ORTIZ, DEBORAH FAMILY CHILD CARE	FACILITY NUMBER: 543903669
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Records - Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above; which poses a potential health, safety or personal rights risk to persons in care. Inspection Tool Notes: Licensee is unable to provide records for children enrolled at time of visit.
	POC Due Date: 07/29/2019
	Plan of Correction
1 2 3 4	Licensee will obtain completed records for all children enrolled by 07/29/2019. A return visit will be required.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC809 (FAS) - (06/04)

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