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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400336
Report Date: 02/04/2022
Date Signed: 02/04/2022 05:27:39 PM

Document Has Been Signed on 02/04/2022 05:27 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:ORDAZ FAMILY CHILD CAREFACILITY NUMBER:
198400336
ADMINISTRATOR:ORDAZ, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 484-9865
CITY:BELLSTATE: CAZIP CODE:
90201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 21CENSUS: 5DATE:
02/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Diana Ordaz, LicenseeTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. LPA met with Diana Ordaz, Licensee. LPA explained the purpose of the inspection and provided with and explained the inspection Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected all rooms/areas on the facility sketch including off limit areas. Also, present was Consuelo Rodarte, Assistant. There were 6 children present, including 1 infant.
At 1:56PM LPA observed Child #1, buckled and sleeping in a car seat (photo taken). This poses an immediate risk to the health and safety of children in care.
Individuals residing in the home were discussed and noted.
This facility is a single family home that consists of two (2) bedrooms, one (1) bathroom, living room, dining room, den, kitchen and shaded patio.
The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas used by children include: Living room, dining room, kitchen, den, bathroom, and shaded patio. Areas off limits include: Bedroom 1 and bedroom 2 front yard.

The home was observed to be clean and orderly and has central heating and air conditioning. There are outlet covers throughout the home. LPA observed knives and sharp objects in kitchen cabinet inaccessible to children in care. Cleaning products are stored in locked cabinet under kitchen sink as well as bathroom sink. Licensee was reminded to check locks regularly to make sure they are working.

The required (2A10BC) fire extinguisher was observed in the kitchen. Smoke detectors and carbon monoxide detector was observed, tested and found to be operable.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336
VISIT DATE: 02/04/2022
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The following was observed and reviewed during this inspection:
LPA observed required posted documentation by the door in the den where parents pick up children. which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form.
LPA reviewed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via lan line and cell phone.
There are toys and other age appropriate material available for children.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Licensee there are no firearms or weapons stored in the home. There are no pets currently in the home.

Isolation area for sick children waiting to be picked up is in the living room, away from the other children.
The bathroom that children use is located in the observed to be clean and free of hazards.

Infant Care: LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Licensee states the following a sleep supervision plan for infants: Infants will nap in the living room where Licensee or assistant provide supervision of infant for the duration of the nap and will document 15 minute checks.

Currently, children are using the side yard and shaded patio for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. The are no pools, spas or other water features.



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)

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336
VISIT DATE: 02/04/2022
NARRATIVE
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LPA observed that Child #1-CHild #6 did not have their immunization records on file, Child #1 and Child #6 do not have a file available, this poses a potential risk to the health and safety of children in care.

Staff records were reviewed for approved Pediatric First Aid and CPR certification (Expires 9/22), LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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


LPA observed that licensee is implementing COVID-19 precautions and procedures.

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 Centers and the ADA, available at: http://www.ada.gov/childqanda.http

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/inspection-process.

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.



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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336
VISIT DATE: 02/04/2022
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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 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.
Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations - LIC 809D

LPA advised the Licensee to access forms and regulations on line at: www.cdss.ca.gov



Whenever a type A is cited: “Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

Licensee was provided with LIC 9224 Acknowledgement of Receipt of Licensing Report

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

Exit interview conducted and report was reviewed with the Licensee, Diana Ordaz



Page 4 - End of Report
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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Document Has Been Signed on 02/04/2022 05:27 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 02/04/2022 at 03:55 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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personal Rights
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
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Type A
Section Cited
CCR
102425(h)
(h) Car seats shall only be used for transportation purposes and shall not be used for sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in Child #1 was observed sleeping and buckeld into a car seat (photo taken), which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee removed the child out of the care seat. Licensee states they will take a class on infant safe sleep and will provide the department with a written plan on how they will follow the infant Safe Sleep regulation. The written plan will be submitted to the department by 2/11/2
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2022


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Document Has Been Signed on 02/04/2022 05:27 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 02/04/2022 at 03:55 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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 6 children, Child #1 and Child #2's files were not available, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/11/2022
Plan of Correction
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Per licensee, the emergency information card will be completed and a copy will be submitted the the department by POC due date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children's record review, the licensee did not comply with the section cited above in 6 out of 6 children's Child #1-Child #6 did not have their immunization record in the file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/11/2022
Plan of Correction
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Per licensee, the immunization record for all children enrolled will be obtained from parents. A copy of the document will be sent to the department by email by POC due 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2022


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Document Has Been Signed on 02/04/2022 05:27 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 02/04/2022 at 03:55 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: ORDAZ FAMILY CHILD CARE
FACILITY NUMBER: 198400336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above Child #1 does not have the LIC 9227 on file, (10 month old infant) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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2
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4
Licensee will complete the LIC 9227 by POC due date prior the child returning to the faciltiy. Licensee will sent a copy of the document by email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2022


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