013422941-6-26-2020-02-CC-CFES-BQXSSM-20200626140809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422941
Report Date: 06/26/2020
Date Signed: 06/26/2020 02:08:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ARRIAGA, ELIZABETH		FACILITY NUMBER:	013422941
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/26/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Arriaga		TIME COMPLETED:	02:15 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	On June 26, 2020 at 1:00PM Licensing Program Analyst (LPA) Catherine Fernandes conducted an announced Case Management Inspection with Licensee Elizabeth Arriaga regarding an increase in capacity via FaceTime. Residing in the home is the licensee, her finger print cleared adult child and one underage child. Present during the inspection was three preschoolers. The home was virtually toured with the licensee to conduct a health and safety inspection. Due to COVID-19 LPA focused mainly on the physical plant of the home and an annual will follow. Operating hours will be 7:00am to 6:00pm, Monday through Friday. The home is a single story house that consists of two bedrooms and two bathrooms. The OFF LIMIT AREAS are all the bedrooms, the converted garage that is being used as a master bedroom and the master bathroom in the bedroom which will be inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room which is the main area of the day care, the kitchen, dining room and the fenced in backyard. The ISOLATION AREA will be in the dinning room near the front entrance of the home. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 3A40BC fire extinguisher in the kitchen and pull down fire alarm on the wall next to the front door, a working smoke detector and carbon monoxide detector, a working telephone, and First Aid Kit. The Licensee's CPR and First Aid certificate is current and expires on November 2, 2021. Per applicant, there are no firearms in the home. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required mandated reporter training for child care providers, which has been completed on 7/3/19. On 02/07/20, a fire clearance was granted to facility #013422941 by Oakland Fire Department. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. Report Continues on 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ARRIAGA, ELIZABETH	FACILITY NUMBER: 013422941
	VISIT DATE: 06/26/2020

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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of June 26, 2020 this home is recommended for an increase of capacity.

There are no deficiencies cited today.
The report will remain on file for three years.
An exit interview was conducted with Licensee. Report mailed and emailed.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020

LIC809 (FAS) - (06/04)

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