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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216663
Report Date: 06/29/2023
Date Signed: 06/29/2023 10:31:16 AM

Document Has Been Signed on 06/29/2023 10:31 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ORTEGA FAMILY CHILDCAREFACILITY NUMBER:
426216663
ADMINISTRATOR:ASHLEY ORTEGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 819-1484
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/29/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Ashley OrtegaTIME COMPLETED:
10:40 AM
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On June 29th, 2023, at 9:04AM Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a pre-licensing inspection. LPA met with applicant Ashley Ortega and discussed the purpose of the inspection. LPA and applicant together toured the interior and exterior of the home. This is a change of location from facility number 426216138.

During this tour the following was noted:

Residing in the home will be applicant, husband (fingerprint cleared) and one (1) child under the age of ten (10). Per applicant, the operating hours will be Monday through Friday from 8:15AM-5:00PM

All areas identified on the facility sketch were inspected. This is a single-story home which consists of three (3) bedrooms, two (2) restrooms, one (1) formal living room, (1) informal living room, kitchen, dining room, garage, and outdoor play area. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Off limit areas included: Two (2) bedrooms, one (1) bathroom, formal living room, kitchen, sunroom, and garage.

Applicants stated that children will have access to: one (1) bathroom, one (1) bedroom, informal living room (aka playroom), dining room and outdoor play area.

LPA observed age-appropriate toys, play equipment and material for children in care. Knives for family use are made inaccessible by kitchen gate. Outdoor play area has age-appropriate toys, soft surface, and shaded area. At the time of the inspection, no bodies of water were present.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ORTEGA FAMILY CHILDCARE
FACILITY NUMBER: 426216663
VISIT DATE: 06/29/2023
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The required fire extinguisher 2A10BC was serviced 7/7/2022. Combination smoke and carbon monoxide detector was tested at 9:27AM and was functioning at the time of the inspection. Applicant was reminded to service or purchase new fire extinguisher yearly. Per applicant, firearms are present on property and LPA observed firearms and ammunition stored separately in locked cases, inaccessible to children.

Lompoc Fire Department cleared property for childcare use on 6/21/2023 notating no childcare use maybe allowed in sunroom.

This home meets Title 22 Division 12 for a Large Family Child Care Home effective today 6/29/2023.

An exit interview was conducted, report reviewed, and copy provided to applicant.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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