444416800-3-1-2023-07-CC-CNEN-CPHRXS-20230301122514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416800
Report Date: 03/01/2023
Date Signed: 03/01/2023 12:25:26 PM

Document Has Been Signed on 03/01/2023 12:25 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ORTIZ, ELISABETH		FACILITY NUMBER:	444416800
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/01/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elisabeth Ortiz		TIME COMPLETED:	12:35 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 Analysts (LPA's), Cortney Nelson and Ashley Lopez, met with Applicant, Elisabeth Ortiz, for announced pre-licensing inspection. The purpose of today's inspection is to ensure home is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA's were admitted into the home by Applicant and toured inside and outside of the family child care home (FCCH). Applicant states that there is one adult over the age of 18 living in the home is her spouse (Willie Victory). Applicant additionally has three minor children living in the home. The hours of operation for the FCCH will be Monday-Friday, 7:30AM-4:30PM and the Applicant is planning to offer care for children ages 0-5 years. Applicant has submitted proof of ownership for the home and does not currently have liability insurance for the day care. LPA advised applicant to provide parents with Affidavit Regarding Liability Insurance (LIC282) upon registration until liability insurance is potentially purchased in the future. Applicant 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. LPA's toured inside the home and observed sufficient materials and equipment for day care children. The Applicant states she is planning to purchase additional toys for the children to utilize while in care. Off limits inside the home include: kitchen, attached garage, two (2) bedrooms, master bedroom, and master bathroom. There is a working telephone (cell phone) at the FCCH. Applicant currently has six (6) cots and one (1) crib available for napping. LPA's advised that sheets should be changed between infants, if the crib is shared. Applicant states that she does plan to administer medication and provide Incidental Medical Services (IMS) to children as needed. Food will be prepared and provided by the FCCH, Applicant states that she plans to serve breakfast, lunch, and AM/PM snack. LPA's observed cleaning compounds and kitchen knives properly stored inaccessible to children. Applicant states there are no weapons or firearms in the home.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ORTIZ, ELISABETH	FACILITY NUMBER: 444416800
	VISIT DATE: 03/01/2023

NARRATIVE

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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 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.

LPA's toured outside the home and observed the back patio is fenced in and the Applicant states that she is planning to utilize the space for the care of children. LPA's requested that the Applicant submit photos of the back patio area once it has been cleared of hazardous materials and fully prepared for children. The Applicant states that she is planning to add a play structure to the patio and LPA's advised that resilient material, such as padding, is placed under the play structure as the patio surface is cement. Off-limits outside the home include: front yard. No outdoor bodies of water were observed during todays inspection.

LPA's observed fully charged 3A40BC fire extinguisher (last serviced: 2/2023), working smoke detector and carbon monoxide detector. LPA's advised completing annual maintenance for fire extinguisher. Applicant was provided fire/emergency disaster drill log and was advised it should be completed every 6 months.

The Applicant states that for discipline of the children, she will talk with the child or redirect to another activity. The Applicant states that she may create a "calming area" for the child and LPA's advised that recommended duration for "time out" as 1 minute per year of age for the child.

Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen. LPA's discussed isolation of sick children with the Applicant and she states that if a child were to start feeling sick at her home that she would isolate the child on the far end of her living room until parents are able to pick-up.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ORTIZ, ELISABETH	FACILITY NUMBER: 444416800
	VISIT DATE: 03/01/2023

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LPA's additionally discussed supervision of children, unusual incidents (LIC624B), and requirements for additional staff/ adults living in the home. The Applicant states that she does not plan to transport children and understands that she must be home at least 80% of the time FCCH is open.

LPA's reviewed small family child care home capacity requirements with the Applicant and provided copy of 102416.5 Staffing Ratio and Capacity from California Code of Regulations. LPA's advised the Applicant that infants are children under 2 years of age. The Applicant understands the requirements of one (1) child in kindergarten or elementary school and at least one (1) child age six (6) for capacity of eight (8) and that there should never be more than four (4) infants present at the FCCH. LPA's advised the Applicant that her minor son will be included in her capacity/ratio until he turns ten (10) years of age.

LPA's discussed required postings with Applicant and provided copies of Parents Rights bulletin (PUB394) and Earthquake Preparedness Checklist (LIC9148). LPA reviewed and provided documents to Applicant for children's files, personnel files, and facility records (LIC311D). LPA's discussed Provider Information Notices (PINs). LPA's additionally reviewed CCLD website, Santa Cruz County Resource & Referral, and online annual fee payment.

LPA's discussed the safe sleep regulations with the Applicant and provided 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.

Exit interview conducted and report was reviewed with the Applicant, Elisabeth Ortiz.

LPA's advised applicant that a small family day care license will be issued pending manager review and completion of the following corrections:
-Install baby gates at top and bottom of stair case as well as entrance to kitchen.
-Make inaccessible items from bathroom, such as shampoos/conditions/lotion, and add locks to bathroom cabinets
-Remove items from patio area and submit photos of completed patio area
-Submit waiver request for fireplace in living room
-Submit photos of additional toys/play equipment purchased for children to play with inside the home
-Adjust sheet in crib to be tightly fitted on mattress
-Submit photo of required postings

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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