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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209808
Report Date: 11/21/2022
Date Signed: 11/21/2022 05:40:53 PM

Document Has Been Signed on 11/21/2022 05:40 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ORNELAS FAMILY CHILD CAREFACILITY NUMBER:
426209808
ADMINISTRATOR:GRACIELA ORNELASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 310-2886
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Graciela OrnelasTIME COMPLETED:
05:55 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 11/21/2022, at 1:55 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection. LPA met with Graciela Ornelas, Licensee,and Andrea Espinoza, Assistant.
The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 3 children and 2 infant in care at the time of the inspection. When LPA arrived to the FCCH, LPA observed C1 strapped in the car seat, with the bottle propped up. The licensee advised LPA that C1 also sleeps in the car seat, per mother's request.

The main day care areas are living room, dining room, kitchen, bedroom #1, bedroom #3, day-care room and bathroom. LPA observed in the children's bathroom, bedroom #1 and bedroom #3, Listerine, deodorant, prescription medications, lotion, razors and personal hygiene accessible to children in care. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. The backyard is completely fenced. LPA observed on the right side of the house oil filter, oil pan, edger, box spring, lawn mower and tools, accessible to children. No bodies of water were observed.

Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. The fire extinguisher was observed and was serviced January 6, 2022. There is a functioning carbon monoxide detector that was tested at 2:22 pm, that meets statutory requirements, and was functioning at the time of the inspection. LPA observed two smoke detectors at the time of the inspection, but neither one of the smoke detectors were functioning at the time of the inspection. Licensee is are current with immunization required per SB 792. The last Safety drill was conducted and documented was November 21, 2022. Licensee is current with CPR and First Aid which expires September 29, 2023. Licensee
THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ORNELAS FAMILY CHILD CARE
FACILITY NUMBER: 426209808
VISIT DATE: 11/21/2022
NARRATIVE
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completed the Mandated Reporter Training required per AB 1207, on October 5, 2021. The assistant Mandated Reporter Training required per AB 1207, and immunization required per SB 792, were not available at the time of the inspection.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed with Licensee the Safe Sleep Regulation (PIN 20-24_CCP-SP), the Effcts of Lead and What is Carbon Monoxide.. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish by LPA Jimenez.

Today, deficiency cited under Title 22 Division 12, Spanish Appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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Document Has Been Signed on 11/21/2022 05:40 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/21/2022 at 04:34 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ORNELAS FAMILY CHILD CARE
FACILITY NUMBER: 426209808

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation LPA observed in the children's bathroom, bedroom #1 and bedroom #3, Listerine, deodorant, prescription medications, lotion, razors and personal hygiene accessible to children in care. LPA observed on the right side of the house oil filter, oil pan, edger, box spring, lawn mower and tools, accessible to children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2022
Plan of Correction
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Licensee will submit photo of the items mentioned above inaccessible to children in care, to CCLD by 11/22/2022, via email to: Martina.Jimenez@dss.ca.gov
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation and interview with licensee C1 strapped in the car seat, with the bottle propped up. The licensee advised LPA that C1 also sleeps in the car seat, per mother's request, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2022
Plan of Correction
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Licensee will submit in writing how licensee will prevent future incidence to CCLD by 11/22/2022, via email to: Martina.Jimenez@dss.ca.gov
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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022


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Document Has Been Signed on 11/21/2022 05:40 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/21/2022 at 04:34 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ORNELAS FAMILY CHILD CARE
FACILITY NUMBER: 426209808

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observed two smoke detectors at the time of the inspection, but neither one of the smoke detectors were functioning at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will submit a copy of receipt and photo of correction to CCLD by 11/28/2022, via email to: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee and record review, revealed that licensee does not check or document infant sleep every 15 minutes, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will submit a photo of safe sleep charts for C1, C2 & C3 to CCLD on 11/28/2022, via email to: Martina.Jimenez@dss.ca.gov
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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022


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Page: 4 of 7
Document Has Been Signed on 11/21/2022 05:40 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/21/2022 at 04:34 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ORNELAS FAMILY CHILD CARE
FACILITY NUMBER: 426209808

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview licensee, assistant and record review revealed the assistant Mandated Reporter Training required per AB 1207, were not available at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will submit a copy of mandated reporter training certificate to CCLD on 11/28/2022, via email to: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview licensee, assistant and record review revealed the assistant immunization required per SB 792, were not available at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.


which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will submit a copy of immunization required per SB 792 to CCLD on 11/28/2022, via email to: Martina.Jimenez@dss.ca.gov
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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 11/21/2022 05:40 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/21/2022 at 04:34 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ORNELAS FAMILY CHILD CARE
FACILITY NUMBER: 426209808

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee and record review, revealed C1 & C3 files did not have an individual infant sleep plan (LIC 9227), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will submit a photo of safe sleep plan (LIC9227) for C1 & C3 to CCLD on 11/28/2022, via email to: Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022


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