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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215676
Report Date: 08/23/2021
Date Signed: 08/23/2021 02:49:03 PM

Document Has Been Signed on 08/23/2021 02:49 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:ORTIZ FAMILY CHILD CAREFACILITY NUMBER:
566215676
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Juana OrtizTIME COMPLETED:
03:00 PM
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On August 23, 2021 at 1:21 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA conducted Covid-19 screening questions prior to entering the home. LPA met with licensee Juana Ortiz and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was zero children in care at the time of the inspection.

The home is a single story residence and licensee uses the living room, dining room, family room, one bedroom, bathroom, kitchen, and backyard for the day care. LPA observed a lock on all other bedroom doors making it inaccessible to children in care. LPA observed a hot tub in the backyard with a cover and clip locks on the front. Licensee states that there are firearms and ammunition in the home. LPA observed the firearms and ammunition are locked and stored separately in two different safes. LPA did not observe toxins/hazards accessible to children in care. In the family room, LPA observed a fireplace in the with a screen in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a fenced wall. Licensee has age appropriate toys in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the dining room with a purchase date of 8-23-2021. Licensee has CPR and first aid Pin 21-07 posted and attestation form has been filled out. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 8/23/2021.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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: ORTIZ FAMILY CHILD CARE
FACILITY NUMBER: 566215676
VISIT DATE: 08/23/2021
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All required forms are prominently posted for parent's or authorized representatives to view in the family room. A roster of children in care was observed current. A sampling of children's records were reviewed and found complete. LPA observed Identification and Emergency Notification forms (LIC 700). Licensee has two dogs and all vaccines are current.

LPA spoke with licensee regarding safe sleep regulations. Licensee does not currently have any infants enrolled.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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:http://www.ada.gov/childqanda.htm

No deficiencies were cited during today's visit.



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: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC809 (FAS) - (06/04)
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