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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434401958
Report Date: 07/14/2023
Date Signed: 07/14/2023 10:17:31 AM


Document Has Been Signed on 07/14/2023 10:17 AM - It Cannot Be Edited

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:ARGUELLES, BERTHAFACILITY NUMBER:
434401958
ADMINISTRATOR:ARGUELLES, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 243-8267
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:14CENSUS: 9DATE:
07/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Bertha ArguellesTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with Bertha Arguelles, licensee, in a case management inspection. Licensee and her helper Gloria were providing care to nine children today included four infants and five preschool age.
On a recent inspection, it was determined that licensee Bertha Arguelles allowed employee Elda Diaz Cendejas to work with the children in Bertha’s Family Child Care Home (FCCH) for the period 2/27/23 to 3/19/23 as Bertha has stated before, without having a criminal records clearance. Elda livescan was submitted on 3/17/23 and Elda was cleared and associated to Bertha’s FCCH until 3/19/23.

Licensee Bertha Arguelles was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
A civil penalty of $500.00 was assessed today.
A type A deficiency was cited today.
LPA discussed the requirements of AB633 to licensee. LPA provided her the AB633 fact sheet, and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee stated she understands the requirements. Upon receipt, licensee shall post 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.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023
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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Document Has Been Signed on 07/14/2023 10:17 AM - It Cannot Be Edited

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: ARGUELLES, BERTHA
FACILITY NUMBER: 434401958

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2023
Section Cited
CCR
102370(d)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or (2)Request a transfer of a criminal record clearance as specified in Section 102370(j) or
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Licensee shall post 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.
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 (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.Licensee Bertha Arguelles allowed employee Elda Diaz Cendejas to work with the children in Bertha’s Family Child Care Home (FCCH) for the period 2/27/23 to 3/19/23 as Bertha has stated before, without having a criminal records clearance. LPA observed the employee is not longer working at Bertha's FCCH.
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 Licensee will submit to Licensing Program a copy of the signed forms lic9224 on or before 7/17/2023.
LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements.

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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023
LIC809 (FAS) - (06/04)
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