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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910232
Report Date: 10/13/2021
Date Signed: 10/13/2021 01:53:54 PM

Document Has Been Signed on 10/13/2021 01:53 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
153910232
ADMINISTRATOR:BARAJAS ARCINIEGA, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 380-8845
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Licensee, Sandra BarajasTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/13/21, Licensing Program Analyst (LPA), Jose Penate, conducted an unannounced Annual Required Inspection and was met by Licensee, Sandra Barajas-Arciniega. Days and hours of operation are Monday – Friday; 6:00 AM to 6:00 PM or as arranged.
LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and the areas of the home that day care children will have access to are the living room, dining room, kitchen, and hallway bathroom. All other rooms are off-limits and made inaccessible child safety locks. Upon arrival LPA observed dog feces in the living room where children have access to. LPA also observed a child crawling in the area where the feces was located. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition at this home. LPA observed in the hallway bathroom shampoo, toothpaste, tick and flea shampoo, and ajax that are accessible to children in care. LPA observed child locks on all drawers but unfortunately, they are not engaging properly which allows children to all items.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (661) 380-8845.

There are 2 infants in care, LPA discussed infant under the age of 12 months must sleep in cribs and play yards and will be kept free from all loose articles and objects while infants are sleeping. LPA did not observe a crib or playpen for infant under 12 months in care. LPA discussed with licensee that Infants shall not be swaddled while in care. LPA discussed Individual Infant Sleeping Plan for infants up to 12 months of age. Infants up to 12 months of age will be placed on their backs for sleeping. LPA discussed with licensee that when children are in highchairs they must be utilized to the direction given by the manufacturer (eating-buckled in-etc).

Continued on LIC 809-C

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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Document Has Been Signed on 10/13/2021 01:53 PM - It Cannot Be Edited


Created By: Jose Penate On 10/13/2021 at 12:26 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 153910232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed dog feces in the living room and backyard, both of the areas children have access to. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2021
Plan of Correction
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Licensee will ensure that the facility will be clean and orderly prior to children arriving to the facility.
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation in the hallway bathroom LPA observed cabinets and drawers with a faulty child locks. Shampoos, Toothpaste, Ajax, cleaning products, flea and tick shampoo, observed in the hallway bathroom accessible to children. This poses a potential health and safety risk to children in care.
POC Due Date: 10/22/2021
Plan of Correction
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Licensee will ensure that child safety locks are engaging properly and if locks are not working properly items will be removed from the drawers and placed in a area that is not accessible to children.
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/13/2021 01:53 PM - It Cannot Be Edited


Created By: Jose Penate On 10/13/2021 at 12:26 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 153910232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed in hallway drawer batteries, scissors, tools, and shampoo which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Licensee will place child safety locks on drawers or remove items that should be inaccessible to children in care.
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee stated that she does not have a operable playpen or crib for infant in care and did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Licensee stated that she will purchase a playpen or crib to place infants under the age of 12 month in care while they sleep.
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 153910232
VISIT DATE: 10/13/2021
NARRATIVE
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid is current and will expire 8/29/2023. Mandated Reporter was completed by licensee in 2018, LPA explained to licensee that Mandated Reporter must be completed every 2 years from the previous date of completion. Currently Mandated Reporter is expired.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies cited (See LIC 809-D).

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/13/2021 01:53 PM - It Cannot Be Edited


Created By: Jose Penate On 10/13/2021 at 12:26 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 153910232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee stated that she does not currently document each time she checks or observes infants in care every 15 minutes while they sleep. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2021
Plan of Correction
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Licensee stated that she will document every time she observes an infant under the age of 24 months sleeping and document that the child is breathing, not over heating, thier body temperature, skin color, restlessness, and sleeping position.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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, she completed training in 2018 and was unaware that the training was required to be completed every 2 years. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2021
Plan of Correction
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Licensee stated that she will complete training and submit proof of completion to LPA by POC date. (10/29/2021)
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 10/13/2021 01:53 PM - It Cannot Be Edited


Created By: Jose Penate On 10/13/2021 at 12:26 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARAJAS ARCINIEGA, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 153910232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

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 interview and record review, the licensee did not comply with the section cited above. Licensee stated that she has not completed form LIC 9227 for infant in care that is 12 months or younger. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Licensee will completed form and have child representative sign the form as to when the child rolled over.
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
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