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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416800
Report Date: 02/28/2024
Date Signed: 02/28/2024 04:12:11 PM

Document Has Been Signed on 02/28/2024 04:12 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, ELISABETHFACILITY NUMBER:
444416800
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
02/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Elisabeth OrtizTIME COMPLETED:
04:21 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Elisabeth Ortiz, for an unannounced Required Annual/Random Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were three (3) infants and the licensee present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home and the hours of operation are Monday – Friday, 6:00AM-5:00PM.

The Licensee states that adults, over the age of 18, residing in the home are herself and her spouse (S1). All adults residing in the home have Criminal Background Check Clearance and proof of negative tuberculosis (TB) test. There are minors living in the home and one minor (S2) is approaching eighteen (18) years old. LPA advised that once a minor turns eighteen (18) to complete Livescan fingerprint clearances and obtain negative TB test within 30 days.

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 reviewed the facility roster (LIC9040) and observed the last fire/disaster drill was conducted on 12/20/2023, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. Licensee states that she has a child in care who requires Incidental Medical Services (EpiPen) and does not administer medication at this time. LPA advised that once the EpiPen is received, it shall be stored out of reach of children, not locked, with the proper documentation.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ORTIZ, ELISABETH
FACILITY NUMBER: 444416800
VISIT DATE: 02/28/2024
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Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home include: kitchen, attached garage, and the entire second story. The Licensee has a waiver for a fireplace screen and LPA observed that all conditions are met. The fireplace was not in use and is cool to the touch. There is additionally a toy shelf blocking access to the fireplace itself. There are sufficient age-appropriate materials, toys, and play equipment in the home. Furniture is in good condition and safe for children. Drinking water is readily available for children via large water jugs the Licensee fills at local water refill stations and plastic cups. The Licensee is currently only caring for infants and does not require use of the home restroom, however will let the Department know if that changes if/when older children are in care. There is a working telephone in the facility. Stairs are barricaded appropriately to keep day care children safe. There are no weapons or firearms in the home.

The outside area was inspected and the Licensee utilizes a fenced in patio for children. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: front yard and all areas outside of the fenced patio area. No outdoor bodies of water were observed during todays inspection.

LPA discussed the safe sleep regulations with the 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 the 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.

Four (4) children’s files were reviewed during todays inspection and all required documents were present. LPA reminded the Licensee that documented nap checks are required for infants until they turn two (2) years of age. Documented nap checks shall include name of the infant, time of check, initials of staff member checking on the infant, and the physical state of the child. Nap checks shall be maintained in the infant's file and will be reviewed during annual inspections. LPA further advised maintaining nap check documentation in the child's file, even after the child has turned two (2) years old, do not discard the documentation.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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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: 02/28/2024
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The Licensee and her Spouse's files were reviewed and all required documents were present. The Licensee states that she has obtained liability insurance and LPA observed that the policy is active through 5/23/2024. The Licensee has current CPR/First-Aid that expires 3/26/2024 and Mandated Reporter Training that expires on 3/5/2024. LPA reminded that Mandated Reporter training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. LPA reminded that while children are sleeping, the Licensee shall be on the same floor as sleeping children. The Licensee states that she does not transport any day care children. LPA reminded that car seats shall only be used for transportation and shall not be used for sleeping.

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

During the exit interview, the Licensee, Elisabeth, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

As a result of todays inspection, a deficiency was cited, see LIC809-D.

A 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.

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.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/28/2024 04:12 PM - It Cannot Be Edited


Created By: Cortney Nelson On 02/28/2024 at 03:49 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ORTIZ, ELISABETH
FACILITY NUMBER: 444416800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, observation, and record review, the licensee did not comply with the section cited above as nap checks were not documented for infants in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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The Licensee shall development a method for maintaining documented nap checks every 15 minutes for infants (children two years and under). The nap checks shall include the name of the infant, initials of the staff conducting check, time of check, and physical condition of the infant. The Licensee shall start nap checks immediately and submit completed checks for infants on 3/8/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


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