197493097-12-21-2023-58-CC-SGAN-CYQPZL-20231221104543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493097
Report Date: 12/21/2023
Date Signed: 12/21/2023 10:45:55 AM

Document Has Been Signed on 12/21/2023 10:45 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ORELLANA FAMILY CHILD CARE		FACILITY NUMBER:	197493097
ADMINISTRATOR:	ORELLANA, FABIOLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 419-9684
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 3	DATE:	12/21/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Fabiola Orellana, Licensee		TIME COMPLETED:	10:45 AM

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	Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of a Required-3 Year visit . LPA met with the licensee and toured the home inside and outside at 8:00 am on 12/21/2023. Licensee was present with 3 children (including one infant). All areas identified on the facility sketch were inspected. This is a single story home with 3 bedrooms, and 2 bathrooms with living room, dining room, kitchen, detached storage room, and attached converted garage. Applicant has three dogs (Golden Retriever, Shih Tzu, Maltese) kept in the dog run way to the left side of the house. Child care is provided in the living room, dining room, and in the licensee's bedroom. The bathroom utilized by the children is located in the hallway. Off limit areas include two bedrooms near the bathroom utilized by the children in care, the bathroom located in the hall way near licensee's bedroom, the detached storage room, and the attached garage. Family members residing at facility are: 4 adults ( applicant, her spouse, two adult children ) and licensee's minor daughter (16 years old). There is no pool, spa or other bodies of water on the premises. Children play in the back yard. Parents utilize the main entry door to the facility to drop off and pick up the children. Children eat in the living/dining room and sleep in licensee's bedroom. LPA observed eight cots and three cribs in the bedroom, and two high chairs and one adjustable activity plastic table set with six chairs in the living room. LPA observed age-appropriate toys and a TV secured to the wall in the living room. Page 1

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ORELLANA FAMILY CHILD CARE	FACILITY NUMBER: 197493097
	VISIT DATE: 12/21/2023

NARRATIVE

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Child safety latches on all lower cabinet doors, safety gate at the kitchen entry, and safety bedroom knobs were observed. All electrical outlets in the home were covered.
Licensee reports she has no firearms or weapons in the home. The LPA toured all areas used by children during this inspection. The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. The outdoor play area/back yard was inspected. Children's outdoor play equipment and toys are age appropriate and in good repair. LPA observed the yard to be fully fenced. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen (inspected on 10/24/2023). There is a working smoke and carbon monoxide detectors located in the dining room. The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every month. The licensee completed the Mandated Reporter training on 09/08/2023. The applicant has current pediatric CPR/First Aid training completed on 01/11/2022. Parents provide meals and Licensee provides snacks. Licensee stated that a cell phone with active service in the home will be the main contact number while children are in care.
LPA observed in the living room the Parent Board with all required postings ( Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Car Seat Safety poster). Child Care Facility Roster (LIC9040) was on file.
LPA reviewed children's files. A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card, LIC 9227/Individual Infant Sleeping Plan, and sleep log. Page 2

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ORELLANA FAMILY CHILD CARE	FACILITY NUMBER: 197493097
	VISIT DATE: 12/21/2023

NARRATIVE

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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.

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.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ORELLANA FAMILY CHILD CARE	FACILITY NUMBER: 197493097
	VISIT DATE: 12/21/2023

NARRATIVE

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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 Fabiola Orellana, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Fabiola Orellana.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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