<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596936
Report Date: 12/04/2024
Date Signed: 12/10/2024 11:44:12 AM

Document Has Been Signed on 12/10/2024 11:44 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ORDIWAY FAMILY DAY CAREFACILITY NUMBER:
191596936
ADMINISTRATOR/
DIRECTOR:		ORDIWAY, SHELLY JEANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5629213825
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Shelly Jean OrdiwayTIME VISIT/
INSPECTION COMPLETED:
04:45 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 December 4, 2024, at 1:15pm Licensing Program Analyst (LPA) A. Carter conducted an Unannounced Annual Random Inspection and met with licensee Shelly Ordiway. LPA disclosed the purpose of the inspection and was granted entry into the facility. Licensee was provided a copy of the Facility Entrance Checklist.
All adults associated to the home were found to have criminal record clearance. There was one adult, and four (4) daycare children present during today’s inspection and currently eight (8) children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are Monday thru Friday from 6:00am to 6:00pm. Licensee does not provide overnight care.

LPA observed required posted documentation in the main care living room which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including: LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 10/2/2024.

Smoke and carbon monoxide detector located in hallway of the main care area was tested and are operable. LPA observed the AB10BC fire extinguisher with last service date of February 12, 2024. The facility has central air and heating and maintains telephone service via landline and cell phone.

This is a single story home which consists of three (3) bedrooms, two and half (2 1/2) bathrooms, living room (main care), kitchen/dining room, attached garage, front yard and backyard with a pool. LPA observed a screened fireplace in living room. Main care areas include, living room, kitchen, bathroom, and front yard. The kitchen has a pocket door used to restrict access when the children are not eating. Licensee states children are supervised when in the kitchen. The bathroom accessible to children in care is located in the hallway adjacent to the main care area.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ORDIWAY FAMILY DAY CARE
FACILITY NUMBER: 191596936
VISIT DATE: 12/04/2024
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
26
27
28
29
30
31
32
 Page 2
LPA observed it to be clean and free of hazards. Areas off limits to children and parents include: All three (3) bedrooms, one and a half (1 1/2) bathrooms, attached garage, and backyard with pool. Off limit areas are locked during operating hours, LPA observed doors to be locked making them inaccessible to children in care.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety and comfort of the children.
There are toys and other age appropriate material available for children. LPA observed detergents in off limit area, cleaning compounds are stored in kitchen under the sink with child safety lock, and medicine is kept in off limits bedroom inaccessible to children care. Knives are kept in a locked drawer in the kitchen. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in main care area, supervised and away from other children in care.

Per licensee, food is provided for children in care. LPA reminded licensee that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

Per licensee, the children will have access to the front yard for supervised outside play. LPA observed age appropriate toys such as playhouse, slides, toddler size bikes and cars. LPA observed the front yard has grass and adequate perimeter fencing through-out and all trees, shrubs, and plants are maintained.

There is an in ground pool in the off-limits backyard of the home. The pool is fully fenced in by a gate that self-locks when closed, observed by LPA. The pool is inaccessible to children in care. There is a firearm stored in the off-limits garage, inaccessible to children in care. The firearm and ammunition is stored separately inside a locked gun safe observed by LPA.

Infant Care: Currently licensee has 2 infants enrolled. LPA observed two (2) play yards and sleeping cots in the main care area. Napping equipment does not block entrances or exits. Licensee was advised Infants shall not be swaddled in care. Car seats shall only be used for transportation purposes and shall not be used for sleeping. LPA 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.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ORDIWAY FAMILY DAY CARE
FACILITY NUMBER: 191596936
VISIT DATE: 12/04/2024
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
26
27
28
29
30
31
32
Page 3
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). All required licensing forms are on file.

Licensee files were reviewed for Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, measles, and proof of TB clearance was readily available during today’s inspection.
—CPR Card valid until: 09/29/24
—Mandated Reporter AB1207 Completed: 08/2/22

Licensee stated they do not have any children that needs medication administer, or any children with allergies in care at this time.
Licensee stated that there are no smokers in the home.
Licensee stated there are no pets in the home. LPA did not observe any pets at time of inspection.

During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ORDIWAY FAMILY DAY CARE
FACILITY NUMBER: 191596936
VISIT DATE: 12/04/2024
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
26
27
28
29
30
31
32
Page 4
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep
webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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 PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the Licensee Shelly Ordiway, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


Exit interview was conducted and report was reviewed with the Licensee Shelly Ordiway.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 12/10/2024 11:44 AM - It Cannot Be Edited


Created By: Andrea Carter On 12/04/2024 at 04:22 PM
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: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
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 Mandated reporter training is expired which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
Licensee will complete and submit Mandated reporter certificate to LPA as proof of completion by agreed upon date.
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 Pediatric First Aid/ CPR is expired which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
Licensee will complete and submit Pediatric First Aid/ CPR training and submit certificate to LPA as proof of completion by agrred upon date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Andrea Carter
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5