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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010208178
Report Date: 10/19/2023
Date Signed: 10/19/2023 08:40:40 AM

Document Has Been Signed on 10/19/2023 08:40 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ORTIZ, MELISSAFACILITY NUMBER:
010208178
ADMINISTRATOR:ORTIZ, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 471-6927
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Melissa OrtizTIME COMPLETED:
11:02 AM
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Licensing Program Analyst Sidney Cortez, met with licensee Melissa Ortiz , for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Melisa Ortiz, and her fingerprint cleared husband (David Ortiz), fingerprint cleared staff member Carolyn Chew and 1 infant, and 2 pre-school age children (3 total children)

The home was inspected to conduct a Health and Safety Inspection. The facility currently operates from 7:00AM until 5:30 PM, MONDAY-FRIDAY. The home is a one story home which consists of living room, family room, kitchen, 3 bedrooms, 1 bathroom, front yard, backyard, and day care room.

The on limit areas are the living room, the bathroom, kitchen and the day care room to the right of the kitchen, as well as the patio to the right of the day care room.

The OFF LIMIT AREAS are the 3 bedrooms which will be inaccessible by closed and/or locked doors and visual supervision. The day care room has ventilation for safety and comfort. The ISOLATION AREA will be the living room. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children.
There are age appropriate toys, furniture and equipment.. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Per licensee, there are no firearms in the home.

The licensee’s Health and Safety training is completed and CPR and First Aid certificates are current and expires OCT 2024.

The licensee's mandated reporter training is current and expires (AUG, 2025). The licensee conducts and documents fire and disaster drills twice a year with the last one conducted in OCT 2023.
2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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