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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314125
Report Date: 01/04/2023
Date Signed: 01/05/2023 04:18:42 PM

Document Has Been Signed on 01/05/2023 04:18 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:DUQUE GONZALEZ, LORNAFACILITY NUMBER:
304314125
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ApplicantTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced in-person Pre-Licensing inspection for the purpose of re-locating from license # 304313788 for a new Small Family Child Care home. LPA met with Applicant, Lorna Duque Gonzalez who provided a tour of 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.

Applicant is requesting for a Small family childcare home license. Operation hours will be Monday to Friday 6:00 AM to 10:00 PM and care and supervision will be provided to children ages 3 months old to 13 years old.
All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single one story home with 2 bedrooms, 1 1/2 bathrooms, Family room, living room, kitchen, and back yard.
Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. Telephone service (cell phone is the primary contact phone) .

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in the locked garage and top cabinets. The Licensee states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DUQUE GONZALEZ, LORNA
FACILITY NUMBER: 304314125
VISIT DATE: 01/04/2023
NARRATIVE
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Based on the Facility Sketch submitted, areas off limits to children are: .

Parents and children will enter the home, through the main entrance door, leading to day care area. The applicant has designated family room for day care children. There is one half bathroom designated for children usage. The family room (Children's area) has been separated by a baby gate from the kitchen and the living room. The applicant was advised to escort the children to and from the bathroom because the bathroom is located in the off limit area next to the bedrooms.

The designated day care area is the family room which is for eating, playing, reading, and day care activities. This room was observed to have age appropriate activities and educational items for enrolled children. There were two pack and play for napping infants. There are cots available for napping of older children.

Beddings are provided by the applicant. Applicant shall provide ongoing supervision during nap time. Every 15 minutes check on children under 2 years old and documenting on the log was discussed with applicant, Lorna Duque Gonzalez and copies were provided.

The garage is locked and is inaccessible to children. Licensee will use the cell phone for day care 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.

Licensee 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.

LPA discussed the sleeping infants with the applicant, Lorna Duque Gonzalez.



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.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DUQUE GONZALEZ, LORNA
FACILITY NUMBER: 304314125
VISIT DATE: 01/04/2023
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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 applicant has provided the proof of control of property to LPA.

The children's bathroom is located in the hallway by the bedrooms for children's use. There were no hazardous items observed. The children's bathroom was observed to be safe and free of hazardous items.

Applicant provides AM/PM snacks and lunch to children. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

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,

OUTDOOR PLAY AREA: Applicant's has a back yard. Back yard is all fenced. The backyard is designated for children's use. There is a trampoline in the back yard with netting around it. The applicant stated that the trampoline does not belong to her and will be removed from the back yard. She just moved in and that type of equipment is on the list to go.

There are no pets, firearms, weapons, bodies of water in the home.

The fire extinguisher met the licensing requirements. The applicant has the right size of 2A10 BC fire extinguisher. Smoke and carbon monoxide detectors were tested and are operable. LPA observed the fire extinguisher was kept on the wall in the family room (day care area). Smoke detector/ Carbon Monoxide are mounted on the ceiling and are operable.

Applicant has completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 5/2024.



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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DUQUE GONZALEZ, LORNA
FACILITY NUMBER: 304314125
VISIT DATE: 01/04/2023
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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.

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, and any other items that falls into that category are not permitted in the facility.

Applicant 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



LPA discussed the following items with the Applicant, Lorna Duque Gonzalez during the Exit interview:

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: DUQUE GONZALEZ, LORNA
FACILITY NUMBER: 304314125
VISIT DATE: 01/04/2023
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Criminal Record statement: Applicant, Lorna Duque Gonzalez 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.


Safe Sleep : LPA discussed the safe sleep regulations with applicant, Lorna Duque Gonzalez & 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, Lorna Duque Gonzalez the 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.

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, Lorna Duque Gonzalez and 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. (LPA gave the LIC 311D with all the required forms and Fire logs to be maintained in the home). A packet of enrollment for children and posting forms were reviewed with applicant. A sample of very 15 minutes check log was given to applicant.

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.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: DUQUE GONZALEZ, LORNA
FACILITY NUMBER: 304314125
VISIT DATE: 01/04/2023
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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.


OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

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 (Small Family Child Care Home) with Title 22 Regulations


A license for a small family childcare home will be issued after final review and management approval.



Exit interview was held with applicant, Lorna Duque Gonzalez and appeal rights were presented.

End of report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC809 (FAS) - (06/04)
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