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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313789
Report Date: 11/20/2023
Date Signed: 11/20/2023 04:16:41 PM

Document Has Been Signed on 11/20/2023 04:16 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LUNA, ALEXIS & RAMIREZ, OLIMPIAFACILITY NUMBER:
304313789
ADMINISTRATOR:LUNA, A. & RAMIREZ, O.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 315-2006
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/20/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Olympia RamirezTIME COMPLETED:
04:40 PM
NARRATIVE
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On 11/20/2023, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 3 Year inspection assisted by licensee Olimpia Ramirez and Alexis Luna. Upon arrival, the licensee and one volunteer had six (6) clients in care, including one infants. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

INDOOR INSPECTION. The LPA inspected the indoor family daycare area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care by means of child gates and locks. During the inspection the LPA observed an infant sleeping in a play yard with loose articles, including a blanket and stuffed dolls (See 809D). The licensee removed the loose articles while the LPA was still present.

The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The licensee agrees to maintain telephone service in the home when clients are in care. Hours of operation are 6AM to 6PM Monday through Friday. The licensee is aware that each family daycare shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was documented on 5/17/2023 (See 809D). The fireplace is covered with a metal screen.

The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. Clients nap on cots and infants in play yards. According to the licensee, beddings are stored individually and washed weekly. The facility provides age-appropriate toys, play equipment, and materials for the clients served.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/20/2023 04:16 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 11/20/2023 at 02:57 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 of 1 play yards, which poses an immediate health, safety or personal rights risk to persons in care. The LPA observed a play yard hnad loose articles inside and a blanket hanging on its side while an infant was napping. The articles included a second blanket and stuffed dolls. Infant C1 was napping inside the play yard.
POC Due Date: 11/21/2023
Plan of Correction
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The licensee removed the loose articles from inside the play yard and removed the blanket from the side of the play yard. The licensee stated she will email a written statement stating she understands the regulations requires that no loose articles are left inside the play yard even if the play yard is not being used.
Type A
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with licensee Olimpia, the licensee did not comply with the section cited above in 1 of 1 infant, which poses an immediate health, safety or personal rights risk to persons in care. Upon records review, the LPA observed no 15-minute checks. The licensee stated she does not do the 15 minute checks.
POC Due Date: 11/20/2023
Plan of Correction
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The licensee wil begin carrying out and documenting the 15 mintue checks. The licensee will send a copy of one week worth of 15 minute safe sleep checks to the LPA no later than 12/06/2023 to the emial provided.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023


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Document Has Been Signed on 11/20/2023 04:16 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 11/20/2023 at 02:57 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 1 of 1 disaster drills, which poses/posed a potential health, safety or personal rights risk to persons in care. A records review shows that the last drill was documented on 5/17/2023, which is over 6 months prior to the date of the visit.
POC Due Date: 12/20/2023
Plan of Correction
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The licensee will conduct and document a disaster drill and send a copy of the LPA via email no later than 12/20/23.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 1 of 1 volunteer, which poses/posed a potential health, safety or personal rights risk to persons in care. During records review the LPA observed the volunteer's immunizations were not in file.
POC Due Date: 12/20/2023
Plan of Correction
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The licensee will send a copy of the volunteer's immunization record to the LPA no later than 12/20/23 to the email provided.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023


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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789
VISIT DATE: 11/20/2023
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ON-SITE FOOD PREPARATION: The licensee provides food to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The outside play area was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well-maintained and free of any observable hazards. There are no bodies of water in the facility.

PERSONNEL RECORDS: The LPA reviewed the licensees’ and the volunteers files. The licensee’s files were in compliance and included a current Pediatric CPR and First Aid certificate and current mandated reporter. The volunteer’s file was missing a copy of an identification and contact information (a Technical Violation was issued) and proof of immunization (See 809D).

CHILDREN’S RECORDS: The licensee has a current roster of clients. The LPA reviewed 5 children’s files, including one infant. The files were in compliance. An lic9227 was in file for the infant. The licensee stated she does not document the 15 minute safe sleep checks for the infant and added that she stopped doing them because she visually supervises the children while they sleep. A citation was issued (See 809D).

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The licensees understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a qualified substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training].
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789
VISIT DATE: 11/20/2023
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Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

The licensee understands that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789
VISIT DATE: 11/20/2023
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CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/

LPA reviewed the following safe sleep best practices with the licensee:
Always place infants 12 months and younger on their backs to sleep
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, pillows, and stuffed dolls out of the crib or play yard
Pacifiers may be used only if they do not have items attached to them and there is no recall
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for a lightly clothed adult
Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
Conduct and document the 15-minute checks for all infants under 24 months
CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.

The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102425(b) Infant Safe Sleep, 102425(j)(1) Infant Safe Sleep, 102417(g)(9)(A) Operation of A Family Child Care Home, 1597.622(a)(1) General Provisions and Definitions.

LPA A. Silva informed licensees Olimpia that this licensing report dated 11/20/23 documents 2 “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensees Alexis Luna and Olimpia Ramirez that:
A copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care.
A copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report.
A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the child's file for verification of receipt of the report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LUNA, ALEXIS & RAMIREZ, OLIMPIA
FACILITY NUMBER: 304313789
VISIT DATE: 11/20/2023
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The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was posted and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), 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 should be sent to the Regional Manager to the address listed above.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
End of Report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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