304314039-7-6-2022-06-CC-KDEI-CG2QV7-20220705122953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314039
Report Date: 07/05/2022
Date Signed: 07/06/2022 09:24:26 AM

Document Has Been Signed on 07/06/2022 09:24 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:	ORNELAS, JESSICA		FACILITY NUMBER:	304314039
ADMINISTRATOR:	ORNELAS, JESSICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 335-1252
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	07/05/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Licensee Ms. Ornelas, Jessica		TIME COMPLETED:	12:45 PM

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) Desai, Ketki conducted an announced in-person Pre-Licensing inspection for a Large Family Child Care home and it is a Relocation. LPA met with the applicant/ Licensee Ms. Orenlas, Jessica who provided a tour of the new home. Ms. Ornelas, has been a Family Child care provider since 2014. There were no children present at the new home. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office. The applicant is requesting a Large family childcare home license. Per applicant/ Licensee, operation hours will be Monday to Sunday 4:30 AM to 3:30 AM and care and supervision shall be provided to children ages 2 months to 14 years old (Infants to School age children) with three assistants and the Licensee. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story family home with 5 bedrooms, 1 and a half bathrooms, Day care room, (Patio area is converted into a room with proper wooden flooring/ Glass sliding doors with shades and ceiling) kitchen, laundry room is divided into two sections, other side shall be an additional room for day care activities, living area, backyard with two side yards, and front yard. Garage is converted into Master Bedroom. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone for Emergency use. Ventilation and heating. There is central air and heat in the home. Home has ceiling vents for air flow. The A/C unit is in the back yard with a safe barrier on it, making it inaccessible to children. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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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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: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant/ Licensee states (that there are no poisons on the premises). Applicant/ Licensee was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant / Licensee has designated all the 5 bedrooms, kitchen, laundry room, left side yard and one full bathroom as off-limits. There is no stairway, open faced heaters or fire place in the home. Ms. Ornelas has installed two safety gates at the end of the living area making the 3 bedrooms, full bathroom and kitchen inaccessible to children on one side of the home and a second gate is installed next to the Washer and Dryer room, making the laundry room completely inaccessible to children. A third child gate is installed at the entrance of the left side yard making the side yard inaccessible to children. One Bedroom and Garage converted into the Master Bedroom, are accessed from the Day care room, these doors are locked and the keys are hung on the top making these two rooms inaccessible to children. The covered patio is converted into a Day care activity room since the area is added to the Square footage of the home, the construction has been approved by the City. Garage is converted into a room it has a window and wooden flooring but no bathroom in it. Approved by the fire department during the recent inspection.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

The applicant shall use the Cell phone and Land line for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation. Applicant was informed and understands the home is to be free from smoking during hours of operation.

Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Applicant has designated Living area, Day care room, dining area/ one half bathroom, Front / Back yards and right side yard. Children shall enter the home through the front main door of the home. Leading into the living area and adjoining to it, is the Day care activity room, both the rooms were observed to have age appropriate furniture along with educational and play activities for children. Children shall nap in both of the designated rooms for Day care. Children shall nap on the cots, linens shall be provided by the applicant while blankets are brought from home and washed on a weekly basis by the applicant or parents. (2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

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Dining activities shall be held in the Day care activity room, Licensee has placed an age appropriate table and chairs for ages to be served. Licensee/ Applicant shall provides Breakfast/ AM snack/ Lunch/ PM snacks and Dinner to the children, if food is brought from home, these containers shall be labelled with their names by the parents and stored accordingly.Dining room adjoining the kitchen shall be used for dining activity by school age children.

Licensee/ Applicant shall provide Night care to the children. There is proper sleeping bed with the required linens/ blankets for the children. Licensee shall sleep in the bedroom or the living area to provide immediate assistance to the child if needed. All bed clothes shall be provided by the parents.

Designated children's bathroom is in the laundry room. Licensee has installed a safety gate dividing the Laundry room making the other side inaccessible to children. Bathroom is easily accessible from the Day care room . Applicant / Licensee has small step stool and toddler toilet seat for the younger toddlers. There is a cabinet under the sink, with a child safety lock on it. The children's bathroom was observed to be safe and free of hazardous items.

Infant care shall be provided by the Applicant/ Licensee, Living room was observed to have napping portable pac & crib/, there is changing Koala station along with changing mats arranged across the bathroom . All infant items diapers / wipes/ lotions and milk shall be provided by the parents. Mother's milk shall be labeled and stored appropriately. Per Licensee infants shall not be left unattended while they are sleeping.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines, upon entrance temperatures shall be checked, hands shall be sanitized, before children are guided into the designated day care areas.

Applicant has set up a sanitizing station at the entrance door of the house, on a side table.

OUTDOOR PLAY AREA: Licensee/ Applicant has designated the open back yard and right side yard for outdoor activities. It has concrete flooring and grass flooring with a sail for shade. There are age appropriate outdoor toys arranged here along with educational items. Back yard is completed fenced , it shall be accessed from the Day care activity room. Right side yard shall be used for additional activities, it is fenced with concrete flooring. Front yard is also designated for Day care activities, it has a rolling fenced gate which is completely secured with concrete flooring. This rolling fenced gate shall remain locked during operating hours. (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

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LPA's discussed the Safe Sleep practice with the Applicant/ Licensee Ms. Ornelas, Jessica
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant 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 if 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.
Licensee shall maintain LIC 9227 form in the infant file. ( Printed and given to the applicant)

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Per Applicant there are No Firearms/ Weapons / Bodies of Water or Pets in the home.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant/ Licensee has placed the Fire extinguisher on the side wall in front of the main door in the living area. Home has a dual Smoke & Carbon monoxide detector mounted on the ceiling of the living room, passage area and in each of the four bedrooms. Home also has a Fire Alarm system mounted as per the Fire Marshal requirements.

Applicant have completed the required Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 8/08/2022. There are first aid supplies available. Mandated Reporter training is current.

The following was discussed with the applicant: In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license. (4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

NARRATIVE

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Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
The fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian ( Licensee has access to Guardian )

LPA discussed the following items with the applicant/ Licensee Ms. Ornelas, Jessica during the Exit interview:

Criminal Record statement: Applicant/ Licensee Ms. Ornelas, Jessica 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. (5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

NARRATIVE

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Safe Sleep : LPA discussed the safe sleep regulations with applicant / Licensee Ms. Ornelas, Jessica & 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 of the applicant/ Licensee Ms. Ornelas, Jessica 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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.htm.

Review of records to be maintained : LPA reviewed with applicant / Licensee Ms.Ornelas, Jessica the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Subscribe to CCLD important information :Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license -related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option

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/process

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: ORNELAS, JESSICA	FACILITY NUMBER: 304314039
	VISIT DATE: 07/05/2022

NARRATIVE

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Exit interview conducted with the Applicant / Licensee Ms. Ornelas, Jessica this report was read to the applicant.

Fire clearance received from Orange County Fire Authority on 6/13/22, with a specific note: Garage not approved for Day care use.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children, for a Large family child care home and with an assistant provider may provide care for more than 12 and up to 14 children , when one child is enrolled in and attending Kindergarten (including transitional kindergarten) or elementary school, and another child is at least six years old and no more than three infants are in care.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

The facility at the time of Pre-licensing inspection is in compliance for a (Large Family Child Care Home) with Title 22 Regulations. A new License shall be issued upon management approval.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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