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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014052
Report Date: 03/27/2024
Date Signed: 03/27/2024 10:10:40 AM

Document Has Been Signed on 03/27/2024 10:10 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ORTIZ FAMILY CHILD CAREFACILITY NUMBER:
198014052
ADMINISTRATOR:ORTIZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 728-8510
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Ana Ortiz, LicenseeTIME COMPLETED:
10:30 AM
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On March 27, 2024, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management Inspection – Plan of Correction at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with licensee's assistant, Martin Ortiz who guided LPA on a tour of the facility. Licensee, Ana Ortiz Arrived shortly after. LPA did not observe any children in care. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 03/14/2024 were corrected.

Licensing staff observed and reviewed the following:

  • The licensee has moved into the facility, LPA observed some clothing and personal belongings.
  • The licensee states she is at the facility during day care hours
  • LPA observed all adults living in the home are fingerprint cleared and licensee stated her uncleared adult son Edgar has not been at the licensed facility.
  • Licensee stated there has not been any disturbance at the facility
  • Licensee states there have not been any incidents that need reporting but understands the reporting requirement regulation.

LPA obtained a declaration from the licensee stating the following: licensee's uncleared adult son is not allowed in the day care facility, licensee understand that she needs to live at the licensed facility and licensee is not to take day care children to any other facility/home.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 198014052
VISIT DATE: 03/27/2024
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LPA provided licensee with a letter informing her that a meeting will be held at the Regional Office to discuss the facilities history.

Letters of Deficiencies Citations Cleared were provided for deficiencies corrected.

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

An exit interview was conducted, and a copy of this report was provided to Ana Ortiz along with Appeal Rights.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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