434411754-9-1-2022-07-CC-TTRO-CHUSVR-20220901141311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411754
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:13:23 PM

Document Has Been Signed on 09/01/2022 02:13 PM - 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:	ARIAS, CELIA		FACILITY NUMBER:	434411754
ADMINISTRATOR:	CELIA ARIAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 239-0503
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 5	DATE:	09/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Celia Arias		TIME COMPLETED:	11:05 AM

NARRATIVE

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On 09/01/2022 at 10:42 AM, Licensing Program Analysts (LPAs) Teodoro Trujillo and Susy Cervantes met with licensee, Celia Arias, for an annual inspection and explained the reason for the visit to them. Present during today's visit were licensee and their spouse with 5 children: three preschool and two infants. Adults living in the home are licensee, her spouse and adult daughter. Days and hours of operation are Monday through Friday 7:30 AM to 5:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/19/2022 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs inspected inside and outside of the home. LPAs observed no fireplace inside the home, no wall heater, barricaded stairs, and no bodies of water. Licensee stated there are no weapons. Licensee stated they have no pets. LPA observed a new and fully charged 2A10BC fire extinguisher. Carbon Monoxide detector and smoke detectors were operable. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored on top kitchen cabinet. Off limit areas: second floor.

Children were supervised during the visit and LPAs went over substitute options and reminded licensee they could only have 8 children according to their license. Licensee stated they do not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues on report dated 09/01/2022 pg. 1/2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ARIAS, CELIA	FACILITY NUMBER: 434411754
	VISIT DATE: 09/01/2022

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Continuation of report dated 09/01/2022 pg. 2/2
LPAs observed a fire and disaster drill log that was last conducted on 08/12/2022. LPAs reviewed 6 children’s files and observed all required documentation was in compliance. The 15 minute check sleep log for infants under 24 months was discussed, licensee provided completed sleep logs, LPAs reviewed and observed they were in compliance. LPA observed that the Licensee has Mandated Reporter training, training was completed on 107/04/2022. Licensee has Pediatric CPR/1^st Aid expiring 08/07/2023. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee, daughter Ana Arias file is missing TB testing clearance.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type B deficiencies were cited during today's visit. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed in Spanish with the licensee, Celia Arias. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 09/01/2022 02:13 PM - 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: ARIAS, CELIA	FACILITY NUMBER: 434411754
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102369(b)(9)

This requirement is not met as evidenced by: Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above, licensee was unable to provide proof of TB clearance for daughter Ana Arias, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/16/2022
	Plan of Correction
1 2 3 4	Licensee will provide to San Jose Regional Office, a copy of TB clearance for daughter Ana Arias by the end of business day 09/16/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

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