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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420728
Report Date: 06/05/2024
Date Signed: 06/05/2024 05:45:07 PM


Document Has Been Signed on 06/05/2024 05:45 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:INIGUEZ, JOSEFACILITY NUMBER:
013420728
ADMINISTRATOR:INIGUEZ, JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 967-0219
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 11DATE:
06/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Jose IniguezTIME COMPLETED:
05:45 PM
NARRATIVE
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On June 5, 2024, at 2:35 PM, Licensing Program Analyst (LPA) Janai McClain met with licensee Jose Iniguez for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection were the licensee's fingerprint cleared assistants, Y. Howell, and L. Howell, seven preschool age children and four infants. Licensee stated that the facility operates from Monday to Friday 8:00 AM to 5:00 PM.

At 3:30 PM LPA observed two non-fingerprint cleared assistants, P. Pineda and R. Garcia.

LPA toured the facility to conduct a Health and Safety inspection. This two story home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The Isolation area will be the first bedroom to the left, away from other children in care.

On- Limit areas are the: Bedroom (1), bathroom in hallway, bedroom (2) to the right of bathroom, living room, kitchen, and backyard

Off- Limit areas are the: Bottom level of home, and detached garage

There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, pull down fire alarm, and telephone. There’s a heater that has a barricade to prevent access by children. Per licensee, there are no firearms in the home.
See 809-C for continuance
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: INIGUEZ, JOSE
FACILITY NUMBER: 013420728
VISIT DATE: 06/05/2024
NARRATIVE
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The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid has been completed and expires 2/2026. Licensee’s Mandated Reporter has been completed and expires 8/15/2024. Fire/disaster drills have been conducted and recorded with the last drill logged 12/6/2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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.

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

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

LPA discussed the safe sleep regulations with 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 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.
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SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: INIGUEZ, JOSE
FACILITY NUMBER: 013420728
VISIT DATE: 06/05/2024
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

LPA Janai McClain informed licensee Jose Iniguez that this report dated 6/5/2024 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Janai McClain informed the licensee Jose Iniguez to provide a copy of this licensing report dated that documents 6/5/2024 any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

There were two Type A and one Type B deficiencies cited during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted. Report and Appeal Rights were reviewed with the Licensee Jose Iniguez.

****************************************************** End of Report ****************************************************

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/05/2024 05:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: INIGUEZ, JOSE
FACILITY NUMBER: 013420728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to the Licensee's Assistant, Patricia Pineda, not having a fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/06/2024
Plan of Correction
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Patricia Pineda shall leave the daycare and the Licensee shall ensure that Patricia Pineda obtains a criminal clearance before being present in the childcare facility. The LPA will return to verify that Patricia Pineda either has a Clearance or is not present in the facility.
Type A
Section Cited
HSC
1596.871(c)(1)(A)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to the Licensee's Assistant, Rosalia Garcia, not having a fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/06/2024
Plan of Correction
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Rosalia Garcia shall leave the daycare and the Licensee shall ensure that Rosalia Garcia obtains a criminal clearance before being present in the childcare facility. The LPA will return to verify that Rosalia Garcia either has a Clearance or is not present in the facility.
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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 06/05/2024 05:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: INIGUEZ, JOSE
FACILITY NUMBER: 013420728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024

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 record review, the licensee did not comply with the section cited above in 1 out of 1 infants as there was no LIC9227 on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2024
Plan of Correction
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Licensee will have the infants parents complete the LIC9227 and email a copy to LPA by 06/19/2024.
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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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