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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000235
Report Date: 03/04/2020
Date Signed: 03/04/2020 02:40:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ARANIVAR, ARICELA M. & GONZALO G.FACILITY NUMBER:
384000235
ADMINISTRATOR:ARANIVAR, A. & G.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 587-0391
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
03/04/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Aricela M. AranivarTIME COMPLETED:
03:00 PM
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Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. There are 11 children (1 infant), licensee, Aricela, co-licensee, Gonzalo and helper present today. Current residents are Aricela, Gonzalo, 24 years old son, 17 years old daughter and 10 years old son. Licensee's daughter is turning 18 years of age next month and she said she will get her fingerprint cleared. All adults living or working in the home have a criminal background check on file. Days and hours of operation: Monday to Friday between 7:00 AM to 6:00 PM.

LPA inspected the daycare areas with Aricela. Day Care Areas (lower level): center playroom, nap room, baby room, bathroom, and backyard. The remaining areas of the house are off-limits. Off limit areas are made inaccessible. The home is free of hazards with proper temperature and ventilation. Per Aranivar, a carbon monoxide detector, smoke detector are working. A fire extinguisher is fully charged.

At 2:00 PM, LPA reviews the children's records and staff records. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. The licensee has a record of children’s immunization. The licensee has a record of training of preventive health and CPR card valid until February 28, 2022. Licensee conducted the fire and emergency drills on December 16, 2019, and a log sheet was reviewed.

Incidental Medical Services (IMS) policy was discussed. A written IMS is on file.
LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee competed for her AB 1207 on 02/27/2020. Co-Licensee will renew his AB1207 soon.

LPA discussed the safe sleep regulation concepts and the handout was provided.
This report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for the next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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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