198020807-5-17-2024-33-CC-SVAA-D5CNLQ-20240517103355

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020807
Report Date: 05/17/2024
Date Signed: 05/17/2024 10:34:26 AM

Document Has Been Signed on 05/17/2024 10:34 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ORTIZ FAMILY CHILD CARE		FACILITY NUMBER:	198020807
ADMINISTRATOR/ DIRECTOR:	ORTIZ, MARYCRUZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 437-3099
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 18	CENSUS: 4	DATE:	05/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Marycruz Oritz		TIME VISIT/ INSPECTION COMPLETED:	10:50 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	At 8:40 am Licensing Program Analysts (LPAs) Saul Valenzuela and Nolan Tcheng conducted an unannounced annual inspection to the above facility. LPAs met with Licensee, Marycruz Ortiz, to whom the reason for the visit was explained. Per Licensee, there are 18 children currently enrolled. There were 4 children present upon arrival. The licensee was observed to be operating within the license capacity limitations. The licensee states that five adults and one child currently live in the home. Per Licensee, there are four assistant in the facility. All adults living in the home have obtained a criminal record clearance. The facility is in the front house of three homes with separate addresses that share a driveway. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard (fenced) and backyard. Daycare areas include: one bedroom, one bathroom in the hallway by the living room, living room, dining room, and outdoor fenced front yard. Per Licensee, areas off limits to children and parents include: Two bedrooms, master bathroom, kitchen, driveway, and back yard. Licensee guided analyst on a tour of the facility. During this visit, all areas identified on the facility sketch that are accessible for children to use were toured and inspected and the following was observed. Page 1 of 5

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 198020807
	VISIT DATE: 05/17/2024

NARRATIVE

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Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the dining room, where parents drop off the children in the morning. A current children’s roster was available for review.

There is telephone service via a landline and cellphone. Hours of operation are Monday – Friday, 6:00 am – 5:00 am. There is ventilation and heating (central).

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. LPAs advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home, and none were observed on this day.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 7/07/23, as indicated on the service tag. Smoke and carbon monoxide detectors were tested and were operable on this day.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 12/12/23.

The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children. Appropriate sleeping arrangements in form of one playpen and cots were observed.

Page 2 of 5

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 198020807
	VISIT DATE: 05/17/2024

NARRATIVE

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Currently, children are using the front yard for outdoor play time. The outdoor play area was observed to be fenced. LPAs observed that the outdoor yard has toys and other materials for children to play with. No bodies of water were observed on this day. There are pets on the premises. LPAs observed birds and 2 dogs to be in the backyard.

LPAs did observed a fireplace in the living room which was barricaded and inaccessible for children in care. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other items that fall into these categories are not permitted in a family child care facility.

Children’s records were reviewed, including emergency information, and were observed to be complete.

Licensee records were reviewed. LPAs observed that the Licensee and assistants have proof of pertussis, measles and influenza immunizations, and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 5/2/23 for the licensee. At: 9:30 am, LPAs observed that two out four assistants were missing their mandated reporter on file.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The Pediatric First Aid and CPR with the American Red Cross for both Licensee and two assistant expires on 1/27/26.

Page 3 of 5

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 198020807
	VISIT DATE: 05/17/2024

NARRATIVE

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LPAs issued an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review to the licensee which documents staff and children’s files reviewed during this inspection.

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.

LPAs 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-andresources/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.
Page 4 of 5

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ORTIZ FAMILY CHILD CARE	FACILITY NUMBER: 198020807
	VISIT DATE: 05/17/2024

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 Marycruz Ortiz, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Marycruz Ortiz.

Page 5 of 5

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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