191596936-9-14-2022-54-CC-JESA-CJ9QFF-20220914120753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191596936
Report Date: 09/14/2022
Date Signed: 09/14/2022 12:08:07 PM

Document Has Been Signed on 09/14/2022 12:08 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ORDIWAY FAMILY DAY CARE		FACILITY NUMBER:	191596936
ADMINISTRATOR:	ORDIWAY, SHELLY JEAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 921-3825
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 3	DATE:	09/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee Shelly Caufield		TIME COMPLETED:	12:10 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	On 9/14/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Shelly Ordiway and informed her of the purpose for the visit. LPA provided Licensee with a copy of the Facility Entrance Checklist. There were 3 children present. Also present was Licensee's spouse. All residents were noted and verified. Facility provides care to children ages 0 to 13 years old . Facility is open Monday to Saturday 4:30AM to 6 PM. This is a one story, 3 bedroom, 2 bathroom home, with a living room, kitchen, attached garage, fenced backyard and fenced pool, and fenced front yard. Per Licensee areas on limits to children are: Living room, kitchen, bathroom, fenced front yard. Per Licensee areas off limits to children are: three bedrooms, one bathroom, garage, backyard and the pool in the back yard. All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed and reviewed a current roster LIC 9040 and a current disaster drill log. Last disaster drill was performed in 8/3/22. There is an operable carbon monoxide detector in the living room and an operable smoke detector in the hallway. LPA observed a 2A10BC Fire Extinguisher in the facility which indicated full and was last serviced February 2022. The home maintains telephone service (cell phone and land line ). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. There are toys and other age appropriate materials available for children to use in the living room and in the front yard . The kitchen is on limits but there is a safety gate blocking access to the kitchen. Per Licensee, children are supervised when they eat in the kitchen. Sharp objects, detergents and cleaning compounds were inaccessible to children in care. Knives are kept in a latched kitchen drawer, Cleaning products are in a latched cabinet under the sink. Detergents are kept in the off limits backyard.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ORDIWAY FAMILY DAY CARE	FACILITY NUMBER: 191596936
	VISIT DATE: 09/14/2022

NARRATIVE

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Per Licensee, personal medication is stored in an off limits bedroom . Per Licensee, no children enrolled require medication. The facility has central air and heating. There is a screened fire place in the living room. Children nap in the living room and they are provided appropriate napping equipment. Children use the restroom in the hallway.
Children use the front yard for outdoor play. LPA observed the front yard is fully fenced. Per Licensee, children are supervised while playing outside. Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in a section of the living room, separated from other children. There is a weapon in the facility. It is stored in an off limits area of the home, inaccessible to children in care. There is a pool in the backyard. The entire backyard is off limits to day care children. The pool is inaccessible to children in care. There is a gate preventing access to the pool. There is one pet dog in the home. The dog is contained in an off limits area of the home.
Infant Care: Currently licensee has 3 infants enrolled. There are two play yards available for two infants and one infant naps on a cot. LPA did not observe any blankets or pillows in the play yards. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPAs discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, LPA provided a copy of the infant safe sleep regulation 102425.
Overnight Care: There is no overnight care provided at the moment. LPAs discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed: Children's records contained (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights and the 15 minute infant sleep log.
Staff records were reviewed: Licensee's pediatric CPR/First Aid was completed on 2/27/20. Licensee did not have proof of required immunizations for measles and pertussis. Licensee's Mandated Reporter training was completed on 8/4/22. No other staff was present during the inspection. LPA discussed documents to be on file for staff: proof of measles/pertussis/flu/tb clearance LIC 508, LIC 9108 and LIC 9052.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ORDIWAY FAMILY DAY CARE	FACILITY NUMBER: 191596936
	VISIT DATE: 09/14/2022

NARRATIVE

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During inspection the children present was observed to be treated with dignity and respect, and free from corporal and/or unusual punishment.
Incidental Medical Services (IMS): 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 Center 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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep https://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/safe-sleep as an additional resource. 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. 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.
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D for Type B citations. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview conducted and report was reviewed with the Licensee, Shelly Ordiway . A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/14/2022 12:08 PM - It Cannot Be Edited

Created By: Jeanette Estrada On 09/14/2022 at 11:20 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ORDIWAY FAMILY DAY CARE	FACILITY NUMBER: 191596936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. 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. Licensee did not have an updated pediatric cpr/first aid certification. The Licensee's certification on file expired in February 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2022
	Plan of Correction
1 2 3 4	Licensee will obtain a current up to date pediatric first aid/cpr certification and will provide proof to LPA via picture. Licensee was advised certification shall be EMSA approved.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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. Licensee did not have proof of required immunizations for measles and pertussis which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2022
	Plan of Correction
1 2 3 4	Licensee will obtain proof of required immunizations for measles and pertussis and will provide proof to LPA via picture.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Jeanette Estrada

LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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