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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500168
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:10:52 PM

Document Has Been Signed on 03/07/2024 03:10 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AMBRIZ, JESSICAFACILITY NUMBER:
394500168
ADMINISTRATOR:AMBRIZ, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 608-0039
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jessica Ambriz TIME COMPLETED:
03:20 PM
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On March 7, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Jessica Ambriz for an unannounced 3-Year inspection. During the inspection, LPA observed nine children in care being supervised by the Licensee and two assistants. Facility fees are current. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee stated that she is open seven days a week and does provide overnight care.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



LPA and Licensee toured the facility during the inspection. The facility consists of 3 bedrooms, 1 office, 2 bathrooms, living room, dining room, laundry room, detached garage. There is a shop located in the front right side of the house which will remain locked during childcare hours. The primary shop, car shed/storage shops, detached garage, and open door shed will remain off limits in the front of the home. Additional off limit areas will consist of kitchen, licensee’s bedroom, master bathroom, and licensee’s daughter’s bedroom. Licensee’s home is on approximately ten acres of land. The front and backyard are unfenced. The backyard covers approximately ten acres with a walnut orchard. Licensee will have one hundred percent supervision when children are in the front yard and designated play area. The backyard and side areas of the front yard will remain off limits at all times.

There are no bodies of water on the property. Licensee stated that there are no weapons in the home. Licensee stated there are no pets in the home.

A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPA observed all the required postings are in an area visible to authorized representatives. LPA observed all poisons are inaccessible to children in care.
Report continues on LIC 809C................
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AMBRIZ, JESSICA
FACILITY NUMBER: 394500168
VISIT DATE: 03/07/2024
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After reviewing the facility files, LPA found that Licensee and her assistants have immunization records, Mandated Reporter Training, and CPR certification on file. Licensee’s CPR/First Aid expiration date is 11/2025. Mandated Reporting Training is current. Licensee understands that CPR/First Aid and Mandated reporter trainings must be renewed every two years. LPA observed that all children's files contained appropriate documentation. Children's roster and a fire drill log were observed; the last drill was conducted 1/2024.

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: https://www.ada.gov/resources/child-care-centers/.



LPA discussed safe sleep regulations with licensee and 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 licensee of 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdssca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the Licensee, Jessica Ambriz.

Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiencies were cited during today’s inspection.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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