434413542-3-6-2020-07-CC-SYIP-BMG2UX-20200306164305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413542
Report Date: 03/06/2020
Date Signed: 03/06/2020 04:44:11 PM

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:	ARRIOLA, DENISE		FACILITY NUMBER:	434413542
ADMINISTRATOR:	ARRIOLA, DENISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 313-9406
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	14	CENSUS: 11	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Denise Arriola		TIME COMPLETED:	04:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1 Year inspection. Upon arrival, LPA met with Licensee's spouse, Raul Arteaga, and explained the reason for the inspection. Licensee Denise Arriola arrived shortly after with one child, who was infant age. Upon arrival, there were 10 children, whom two were infant ages. 1 children arrived shortly after. The hours of operation are Monday through Friday 7AM to 5PM. Facility was not in compliance with ratio during today's inspection. LPA discussed with Licensee about the ratio/capacity. Licensee acknowledged that she was not within capacity during today's inspection. License, Emergency Disaster Plan, and Notification of Parent's Rights were posted. There is working phone in the home. LPA toured in the inside and outside of the home with Licensee. The off-limit areas of the home are kitchen, living room, office, laundry room, garage, entire upstairs, and the right side of the backyard. There are stairs and fireplace, which were barricaded. Furniture and equipment, such as play yard, napping mats, tables, and chairs, were observed to be in good condition. LPA observed that there is sufficient amount of toys for children in care. There were no baby walkers observed during today's inspection. Licensee understands that baby walkers or similar items are not permitted in the home. Restroom for children's use was observed to be clean. LPA reminded Licensee that any wipes or diaper cream need to be inaccessible to children. LPA observed a fully charged fire extinguisher, smoke detector, *-------------------continues on 809 dated 03/06/2020 page 2--------------------------------------*

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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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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: ARRIOLA, DENISE	FACILITY NUMBER: 434413542
	VISIT DATE: 03/06/2020

NARRATIVE

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------------------continuation of 809 dated 03/06/2020 page 1------------------------------------

and carbon monoxide detector. The last fire/disaster drill was conducted on 12/12/2019. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used. Licensee has gates that barricade any open areas. Play equipment and toys were observed to be in good condition. LPA reminded Licensee to check play equipment for any cracks.

Licensee does transport children at this time and understands that children cannot be left alone and unattended in parked vehicles. Licensee stated that she does not have any children in care who requires Incidental Medical Services (IMS).

A copy of the facility roster was obtained. 12 children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights and immunization records.

Licensee and her spouse's files were reviewed. Licensee and her spouse have immunization records for measles and pertussis on file. Licensee and her spouse have a valid CPR/1st Aid, which expires on 02/21/2022 and 02/01/2022. Licensee is in the process of completing the Mandated Reporter Training.

The adults living in the home are Licensee and her spouse. All adults have cleared criminal record, child abuse clearance or exemption, and TB test results. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

---------------------continues on 809 dated 03/06/2020 page 3------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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: ARRIOLA, DENISE	FACILITY NUMBER: 434413542
	VISIT DATE: 03/06/2020

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-----------------------continuation of 809 dated 03/06/2020 page 2-------------------------------

LPA also reviewed and provided Safe Sleep and Lead Exposure information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In the areas evaluated during today's inspection, a Type A deficiency was cited. An exit interview was conducted, where this report, citation, plan of correction, and appeal rights were discussed and provided to Licensee Denise Arriola.

LPA also discussed about AB 633 requirement to provided a copy of 809 report dated 03/06/2020 and obtain a signed copy LIC 9224 for each child in care within one business days. LPA also discussed with Director that a copy of this report and a signed copy of LIC 9224 is required for any newly enrolled children within the 12 month period. LPA provided a copy of LIC 9224 and fact sheet to Licensee Denise Arriola.

A Notice of Site Visit has been issued and must be posted for 30 consecutive days; along with a copy of the 809 report dated 03/06/2020.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ARRIOLA, DENISE	FACILITY NUMBER: 434413542
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/09/2020 Section Cited	1 2 3 4 5 6 7	Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evident by:
	8 9 10 11 12 13 14	Based on observation, Licensee had one Assistant present with 7 children. This poses an immediate risk to the health and safety to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

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