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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313617358
Report Date: 10/11/2019
Date Signed: 10/11/2019 12:41:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BARAJAS, CRYSTALEFACILITY NUMBER:
313617358
ADMINISTRATOR:BARAJAS, CRYSTALEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 821-7690
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 14DATE:
10/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Crystale BarajasTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Amanda Blesi and Katrina Owens met with the Licensee, Crystale Barajas, for the purpose of an unannounced Annual inspection. The Licensee's assistants, Amber and Rebecca, were also present upon arrival. LPA asked if anyone else was present in the home today and licensee stated her husband is upstairs off work today. All individuals subject to criminal background review have obtained a criminal record clearance. Today’s census was 14 kids ages 4 months, 6 months, 1, 1, 2, 2, 2, 2, 2, 5, 8, 2, 4 years old. LPA's observed licensee was out of ratio during today's inspection.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the upstairs and garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors.

Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children. Stairs were barricaded. Safe toys and play equipment are observed. The backyard is fenced and gated. There are no bodies of water observed.

Some children’s files were reviewed. A current roster is being maintained. Licensee fire and disaster drills are conducted and documented. CPR and first aid training were verified to be current for licensee and expire March 2020. Mandated Reporter Training (AB 1207) for Licensee/Assistant was also verified.

This provider is currently providing IMS services to children in care. 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.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BARAJAS, CRYSTALE
FACILITY NUMBER: 313617358
VISIT DATE: 10/11/2019
NARRATIVE
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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.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the Licensee can request to be added to the distribution list to receive Quarterly Updates.

LPA provided and discussed the Lead Testing brochure (AB 2370) and updated Blue Immunization Cards (CDPH 286)



LPA reviewed and discussed this facility evaluation report with the Licensee. LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, deficiencies are noted on the following report. See LIC 809-D. Appeal rights provided.

A Type A deficiency is being cited. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided).
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
LIC809 (FAS) - (06/04)
Page: 2 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BARAJAS, CRYSTALE
FACILITY NUMBER: 313617358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/12/2019
Section Cited

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Staffing and ratio: A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
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No more than three infants are cared for during any time when more than 12 children are being cared for. This requirement was not met as evidenced by: LPA's observed 14 children in care, four of whom were infants (under age two). This is an immediate risk to the health and safety of 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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2019
LIC809 (FAS) - (06/04)
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