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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312497
Report Date: 01/09/2020
Date Signed: 01/09/2020 04:27:17 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ARREOLA, CINDYFACILITY NUMBER:
304312497
ADMINISTRATOR:ARREOLA, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 203-4495
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:14CENSUS: 8DATE:
01/09/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Cindy ArreolaTIME COMPLETED:
12:30 PM
NARRATIVE
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA), Jungmi Han. LPA observed licensee and Yvette Giordano, assistant caring for 8 of children; which included 5 of infants, 3 preschool age children. Licensee called child#4’s parents to pick up child#4 immediately to be in ratio as large family child care home. Child#4 was removed from the facility at 10:35 AM by grandmother. Daniel Arreola, staff#2 came to facility at about 9:15 AM. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 3 adults (including the licensee) and 1 of minor child living in the facility.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. LPA observed stairs are not barricaded when LPA arrive at the facility at 8:45 AM. Off limit areas are made inaccessible by child proof door handle nob. The child care areas are the living room that is on the right side of entrance door and backyard that is fenced. The children access backyard directly from child care room. There are working carbon monoxide and smoke detector in the home that meet statutory and State Fire Marshall standards. Fire extinguisher requires recharge. Fire and Disaster drill logs are not updated. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are not firearms or other dangerous weapons in the facility and none were observed during today's inspections. There is a fireplace in the child care room barricaded by wooden piece and inaccessible to children in care. The home has age appropriate toys for the ages served. During today’s inspection LPA observed a bouncer in the child care room under the cabinet. Licensee stated it is donated by a parent. Licensee acknowledged that bouncer is not permitted in a family child care home and removed from child care room immediately. LPA verified there is a working cellular service. There were no poisons or other items observed which could pose a danger to children. There are no bodies of water on the premises.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2020
Section Cited

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102416.5 (d)(1)Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time ...(1)Twelve children, no more than four of whom may be infants. This requirement is not met as evidenced by record review and interview.
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Based on observation, record review, and interview, the licensee failed to ensure to keep no more than 4 infants at the facility. The facility had 5 infants and 3 preschool children at 8:45AM. This poses an immediate Health and Safety risk to the children in care.
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Type A
01/09/2020
Section Cited

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1596.846 (b) Baby walkers (b) A baby walker shall not be kept or used on the premises of a child day care facility. This requirement is not met as evidenced b observation and interview.
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Based on observation and interview, the licensee failed to ensure to not use Baby bouncers. Bouncers are not allowed in the family child care home. There was a bouncer observed at the child care room near the desk/cabinet. This poses an immediate Health and Safety risk to the children 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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102417(g)(3) Operation of a Family Child Care Home. Where children less than five years old are in care, stairs shall be fenced or barricaded.
This requirement is not meet as evidenced by observation.

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Based on observation, the licensee failed to ensure to keep the fence or barricade stairs. LPA observed there is no gate on stairs at 8:45 AM and strairs are currently remodeling. This poses a potential Health and Safety risk to the children in care.
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Type B
01/24/2020
Section Cited

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102417(g)(1) Operation of a Family of a Family Child Care Home (g)The home shall be free from defects... (1)... The home shall contain a fire extinguisher ...which meet standards established by the State Fire Marshal. This requirement is not meet as evidenced by observation.
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Based on observation, the licensee failed to ensure to keep the fire extinguisher which meet standards established by the State Fire Marshal. LPA observed fire extinguisher is not charged. This poses a potential Health and Safety risk to the children 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. (1)The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement is not met as evidenced by:

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Based on interview with licensee, licensee fail to ensure to document the fire and disaster drill log. LPA observed last fire disaster drill log stated as of 10/2016.
This poses a potential Safety risk to the children in care.
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Type B
01/24/2020
Section Cited

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1596.8662.(b)(1)… mandated reporter…proof of completion ...January 1, 2018, is a licensed child care provider..shall complete the mandated reporter training provided...renewal mandated reporter training every two years...This requirement is not met as evidenced by:

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Based on record review of licensee and staff, the licensee failed to ensure to have mandated reporter training certificates for all three staff including licensee. This poses a potential Safety risk to the children 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 8 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
VISIT DATE: 01/09/2020
NARRATIVE
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The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee and assistant’s Pediatric CPR/First Aid certification expired 6/25/2020.

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and staff#2 were reviewed and within compliance. Staff #3’s proof of immunization against measles and Staff#2’s TB test result was not available to review upon request.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. Licensee and two assistants’ mandated reporter training certificates were not available to review upon request.

The licensee will not provide IMS. 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

The licensee understands she must be present in the facility and must ensure children in care are supervised at all times and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.



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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
VISIT DATE: 01/09/2020
NARRATIVE
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CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through www.ccld.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.
A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Staffing Ratio and Capacity 102416.5 (d)(1), Operation of a Family Child Care Home 102417(g)(3), Operation of a Family of a Family Child Care Home 102417(g)(1), Operation of a Family Child Care Home 102417(g)(9)(A)(1), and Application for Initial License 102369(b)(9) and Health and Safety 1596.846 (b), 1596.8662.(b)(1), 1597.622(a)(1) are being cited on the attached LIC 809D.

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
VISIT DATE: 01/09/2020
NARRATIVE
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An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ARREOLA, CINDY
FACILITY NUMBER: 304312497
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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102369(b)(9) Application for Initial License (b) The applicant shall provide all of the following information...(9) Evidence of a current tuberculosis clearance, ... for any adult in the home during the time that children are under care. This requirement is not meet as evidenced by:

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Based on record review, the licensee failed to ensure to keep the Staff#2's TB test record. This poses a potential Health and Safety risk to the children in care.
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Type B
01/24/2020
Section Cited

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1597.622(a)(1) Employee and Volunteer Immunization (1) Commencing September 1, 2016, a person shall not be employed... family day care home if he or she has not been immunized against influenza, pertussis, and measles...This requirement is not met as evidenced by:
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Based on record review, licensee failed to ensure to maintain the Staff#3's proof of Measles vaccine at the facility. This poses a potential Health and Safety risk to the children 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 7 of 8