304313748-9-28-2023-06-CC-PRIS-CW4NPZ-20230928103911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313748
Report Date: 09/28/2023
Date Signed: 09/28/2023 10:39:51 AM

Document Has Been Signed on 09/28/2023 10:39 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ROJAS, MARTHA		FACILITY NUMBER:	304313748
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	09/28/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Martha Rojas, Licensee		TIME COMPLETED:	11:00 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	Licensing Program Analyst (LPA) P Rivas conducted a case management inspection, in response to licensee’s request for a capacity increase. LPA met with licensee, Martha Rojas who guided analyst on a tour of the facility. LPA Rivas observed 4 children (2 infants), one infant was eating in the high chair. The facility was within licensed capacity and the required ratio. The licensee stated there is currently 2 adults and no minor children living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office. The hours of operation are: 7:00am to 5:00pm; M-F. Fire clearance was received with approval of capacity of 12. Licensee is operating within her licensed capacity. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal records and child abuse index clearances or exemptions. The facility is a two-story townhouse/duplex with 2 bedrooms, 3 bathrooms, living room, dining room, kitchen, laundry closet, and backyard that is fenced. The licensee reported the entire second floor is off limits and has placed child proof gate and door handles to prevent children from entering the off-limit areas. The licensee acknowledged the children may never enter the off-limit areas. The licensee has designated the living room, downstairs bathroom next to the dining room, and left side of the backyard as part of the childcare. The licensee has a cell phone that is used for childcare. The licensee was reminded if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. The licensee was reminded the home is to be free from smoking during hours of operation.(duplex neighbor does smoke outside Per LPAs observation)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ROJAS, MARTHA	FACILITY NUMBER: 304313748
	VISIT DATE: 09/28/2023

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
26
27
28
29
30
31
32

Page 2
The facility has central air and heater which is located on the first floor across from the dining table and stays locked with metal hook. The fireplace is located in the living room, and it is barricaded by a large cabinet/bureau approx 3 feet tall, sufficient to cover fireplace. Licensee stated fire place is non operational. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible by means baby locks on each drawer. Poisons/Hazardous items are not stored on site, and none were observed.

The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items were not observed. The licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged. Licensee had to add fire alarm system to get fire clearance.

Licensee was reminded that Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. If an adult is fingerprinted cleared and associated to another facility, licensee must submit a Criminal Record Transfer Request (LIC 9182) or Exemption Transfer Request form (LIC 9188). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of a valid identification issued by State or Federal Government and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult. Failure to complete the clearance process or license association for any adult resident or assistant will result in a civil penalty assessment against the license.

Mandated Reporter Training for licensee and all assistants were current.

LPA reminded licensee of the following information on Safe Sleep Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ROJAS, MARTHA	FACILITY NUMBER: 304313748
	VISIT DATE: 09/28/2023

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
26
27
28
29
30
31
32

page 3
LPA reviewed with licensee the following safe sleep best practices:
· Always place infants on their backs for sleeping.
· Use only a tight-fitting sheet on the crib or play yard mattress.
· Do not hang any items from the crib or above the crib.
· Keep all items, including blankets, out of the crib or play yard.
· Pacifiers may be used as long as they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

The request for capacity increase will be submitted for final review.

No deficiencies noted during today's visit.

Appeal Rights and the appeal rights process was discussed with the applicant. The applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.

An exit interview was conducted in Spanish with licensee Martha Rojas. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3