198001554-10-22-2019-33-CC-FVAZ-BH7TYK-20191022150852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198001554
Report Date: 10/22/2019
Date Signed: 10/22/2019 03:09:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	BARAJAS FAMILY CHILD CARE		FACILITY NUMBER:	198001554
ADMINISTRATOR:	BARAJAS, ANA MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 570-9032
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	10	CENSUS: 8	DATE:	10/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Maria Ana Barajas		TIME COMPLETED:	03:20 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	Licensing Program Analysts Fabiola Vasquez and Ariel Cazares conducted an unannounced Annual/Random inspection. Visit was conducted in Spanish. LPAs met with licensee, Ana Maria Barajas, who guided analysts on a tour of the facility. The licensee's husband was present and has his criminal record clearance. There were 8 children present. This is a one story home which consists of 1 bedroom, 1 bathroom, kitchen, living room, front and backyard (fenced). There is a second home in the back on the same property with a separate address. Children use the bathroom, living room, and backyard for play. Per licensee, areas off limits to children and parents include:1 bedroom, and kitchen. The children walk through the kitchen to go to the back yard, however, there is a kiddie gate blocking the kitchen entrance. Licensee states that there are no weapons or firearms on the premises. LPA did not observe swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and carbon monoxide detectors are present in the facility. Fire extinguisher was serviced 10/7/18 and is due for a service or repurchase. Fireplace was observed barricaded. CPR Card valid until: 01/7/21 for licensee. Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed. Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm Page 1 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BARAJAS FAMILY CHILD CARE	FACILITY NUMBER: 198001554
	VISIT DATE: 10/22/2019

NARRATIVE

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The following was discussed with the Licensee:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

Baby walkers, saucer chairs, bouncers or any similar items are prohibited. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA provided a Safe Sleep resources and materials to licensee on this date.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BARAJAS FAMILY CHILD CARE	FACILITY NUMBER: 198001554
	VISIT DATE: 10/22/2019

NARRATIVE

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All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

It is recommended that First-Aid kits be available on premises. Outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

Forms and updated can be accessed on the Department's website: www.ccld.ca.gov

There were deficiencies observed and cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Exit interview, was conducted with Ana Maria Barajas. A copy of this report and appeal rights were provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BARAJAS FAMILY CHILD CARE	FACILITY NUMBER: 198001554
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/29/2019 Section Cited	1 2 3 4 5 6 7	The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement has not been met as evidenced by the proof of purchased reciept dated 10/7/18 and no service tag.
	8 9 10 11 12 13 14	This poses a potential risk to the health and Safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

LIC809 (FAS) - (06/04)

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