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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310966
Report Date: 02/13/2023
Date Signed: 02/13/2023 10:08:05 AM

Document Has Been Signed on 02/13/2023 10:08 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:OROZCO, HEIDIFACILITY NUMBER:
304310966
ADMINISTRATOR:OROZCO, HEIDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 764-9143
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
02/13/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Heidi and Kimberly Orozco, Licensee and AssistantTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit to verify that the Stipulation and Order is being followed. LPA met with licensee Heidi Orozco and her Assistant Kimberly Orozco. During visit second assistant arrived at 9:20 am.
LPA observed licensee and assistants, caring for a total of 6 children, in which are 2 infants, and 4 preschool age children playing inside the childcare area (living room). Licensee was operating within the licensed capacity as specified on the license. LPA was advised by licensee(in Spanish) that she had been explained and understood the stipulation and order.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 2 adults including the licensee living in the facility. Facility Day care hours are 7:00am-5:00pm, Monday through Friday.

LPA requested and was shown childcare roster which showed 11 children in placement. LPA viewed Licensee's orientation certificate which was dated 09/29/22. LPA viewed 3 hours of training which was observation of children taken 11/08/22 and 3 hours of training Basics dated 11/09/22.
LPA observed missing child policy and stipulation and order posted by door. LPA viewed daily observation log for each child. LPA was advised that LPA Odom had verified all egress or ingress devices. LPA observed alarm system on doors leading to the outside, including a different sounding alarm for the door leading to the garage. LPA observed baby gate in between main entrance of home and living unit. Upon entrance LPA viewed garage door was closed. LPA was advised that there have not been any unusual incidents to report. LPA observed closet used for medication storage to be inaccessible to children.

Cont. on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OROZCO, HEIDI
FACILITY NUMBER: 304310966
VISIT DATE: 02/13/2023
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In the areas that were evaluated no deficiencies were noted under the California Code of Regulations Title 22 Division 12 at the time of the visit.


Exit interview was conducted with Licensee Heidi Orozco in Spanish. Appeal rights were explained (in Spanish) . Licensee was provided copy of appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals must be sent to the Regional Manager at the address listed. A notice of Site visit was posted as per H. & S Code 1596.817. Notice of site visit must be posted for 30 consecutive days . Failure to post will result in civil penalty of $100.00
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC809 (FAS) - (06/04)
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