274450226-5-21-2019-07-CC-FCJO-BCDPSM-20190521113436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274450226
Report Date: 05/21/2019
Date Signed: 05/21/2019 11:35:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ARREOLA, ANA		FACILITY NUMBER:	274450226
ADMINISTRATOR:	ANA ARREOLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 675-3816
CITY:	GONZALES	STATE: CA	ZIP CODE:	93926
CAPACITY:	14	CENSUS: 11	DATE:	05/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ana Arreola		TIME COMPLETED:	11:45 AM

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 Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Ana Arreola, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Fernando, her daughter Analy, and her nephew Arturo.. LPA observed that helper Rosa was present during today's inspection. There were eleven children in care during today's inspection included three infants and eight preschool age. Licensee's certifications for CPR and First Aid are current and expiring on 2/03/2020 and on 05/01/2021 for the Licensee's helper Rosa. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed five children's file and are complete. LPA reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 05/05/2019. Licensee understand a fire drill shall be performed and documented at least one every six months. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limits inside areas are: All the second floor, one bedroom downstairs, the kitchen, the laundry room, the living room and the attached garage. LPA observed there are stairs in the home and are barricaded from the bottom. The home has a fireplace which is barricaded in the on limits day care area. The off limits area outside the home are the left and right side yards. LPA observed the home has a back yard and it is fenced. Licensee uses the back yard as playground whenever the weather allows it. LPA observed that the licensee has a dog in a cage located in the off limits left side yard. Licensee stated the dog has been vaccinated. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detectors and no bodies of water. LPA observed the home has a working carbon monoxide detector. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services (IMS) with the Licensee. ***********************************************Report dated 05/21/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ARREOLA, ANA	FACILITY NUMBER: 274450226
	VISIT DATE: 05/21/2019

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
26
27
28
29
30
31
32

************************************Report dated 05/21/2019 continues from page 1.
Licensee has in file proof of immunization for influenza, pertussis and measles for herself, and for her helper according with the SB792.
A review of staff records on 05/06/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children and ratio (age of the children) shall be observed as well. The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed that the Licensee has proof of completion of the required "mandated reporter" training that all Licensees and helpers are required to complete starting January 1, 2018. Licensee has completed her training on 2/20/2018 and her helper Rosa on 3/24/2019. Licensee understands that all the adults in contact with children are required to take the training. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
LPA advised applicant of the pending Department regulation update re: Safe sleep for infant children. LPA referred the applicant to the Department website: www.ccld.ca.gov for additional information.
No deficiencies were cited during today's inspection. Licensee rights form was printed and given to Licensee. Exit interview was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2