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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310598
Report Date: 08/03/2022
Date Signed: 08/03/2022 10:37:06 AM

Document Has Been Signed on 08/03/2022 10:37 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ORTEGA, MARIAFACILITY NUMBER:
304310598
ADMINISTRATOR:ORTEGA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 731-9463
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Ortega, LicenseeTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced annual inspection.
LPA was assisted by licensee Maria Ortega, also present were 10 children ages 4years old to 12years old. Licensee also had an assistant present during visit.
Due to LPA fall, annual inspection will be conducted at a later date. Licensee was in accord.

Licensee Ms.Ortega 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.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An Exit interview was conducted, report was reviewed in Spanish with licensee. Appeal rights provided.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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