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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408756
Report Date: 04/26/2022
Date Signed: 04/26/2022 04:30:31 PM


Document Has Been Signed on 04/26/2022 04:30 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:FARFAN, ALBALUZFACILITY NUMBER:
073408756
ADMINISTRATOR:FARFAN, ALBALUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 384-9737
CITY:PITTSURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 0DATE:
04/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Albaluz FarfanTIME COMPLETED:
04:30 PM
NARRATIVE
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On 4/26/22 at 1:45 pm Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an unannounced Case Management inspection at Albaluz Farfan's family child care home. No one was home and LPAs contacted Licensee over phone. Licensee arrived minutes later and stated due to a recent incident at home, property landlord Ying Cui took out a restraining order against an adult who worked at the center she owns but continues to live in her home. Licensee Albaluz stated she had to move out of home and close day care indefinitely. Landlord Ying Cui offered employment to Licensee and few other staff while family day care is closed.

During course of inspection, information showed there were 5 employees working at the family childcare home providing supervision and care to children at different periods of time in years 2021 and 2022 but did not have clearance and were not associated to the facility while they worked there.
IDALEEN ALVAREZ - worked in 2021 for more than 5 days, got associated in Feb 2022.
RAQUEL BRANCH - worked and lived in home since August 2021, got associated in Feb 2022
LADEYA HILL - worked in 2021 for more than 5 days, got associated in March 2022
KIRSTEN POOLEY - worked in 2021 for more than 5 days, not cleared or associated yet.
NANCY ACEVEDO - worked for more than 5 days, not cleared or associated yet
This posed/poses an immediate risk to health and safety of children in care. Civil penalty of $2,500 ($500 each for 5 employees who worked at least 5 days at $100 per day for maximum of 5 days)
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: FARFAN, ALBALUZ
FACILITY NUMBER: 073408756
VISIT DATE: 04/26/2022
NARRATIVE
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In another unusual incident that occurred on 4/13/22, Licensee self reported to Licensing Department that an adult Rodquel Branch living in the home got into an argument, screamed and yelled at Landlord Ying Cui. Video of incident was reviewed, and interviews reveal that there were at least 10-12 children present in the home during incident. Per Ying Cui, they were scared, stopped talking and looked at them. This posed an immediate risk to health and safety of children and violated personal rights.
Type A deficiencies are cited today on 809 D page of the report.

LPA Monica Mathur informed Licensee, Albaluz Farfan that this report dated 4/26/22 with 2 Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mathur informed Licensee to provide a copy of this licensing report dated that documents 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.

Due to temporary closure of day care operations, Licensee agreed to email or mail report to existing parents and ensure signed LIC9224 is returned as soon as possible.

Exit interview conducted and report was reviewed with the Licensee, Albaluz Farfan. During signing of report, Albaluz was called out on a personal emergency and she had to leave suddenly. Report will also be emailed to her to obtain remaining signatures.



A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/26/2022 04:30 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: FARFAN, ALBALUZ
FACILITY NUMBER: 073408756

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2022
Section Cited

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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption [...] This requirement is not met as evidenced by:
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Per records review, 5 employees worked at facility providing supervison care to children in 2021-22. 3 out of 5 were associated much later in Feb/Mar 2022 and 2 out of 5 still do not have clearances or association to facility. This poses an immediate risk to health safety of children. Civil penalty $2,500 assessed for 5 employees at $100 per day max for 5 days
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Type A
04/27/2022
Section Cited

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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement is not met as evidenced by:
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During unusual incident of 4/13/22, at least 10-12 children were present during an argument between 2 adults in the home. Children saw the incident, were scared and stopped talking to each other. This posed an innediate risk to health safety of childen in care.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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