434413542-5-6-2022-07-CC-SYIP-CE6V67-20220506160903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413542
Report Date: 05/05/2022
Date Signed: 05/06/2022 04:09:08 PM

Document Has Been Signed on 05/06/2022 04:09 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:	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: 12	DATE:	05/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:24 AM
MET WITH:	Denise Arriola		TIME COMPLETED:	04:20 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. LPA met with Licensee Denise Arriola and explained the reason for the inspection. Upon arrival, present during today's inspection were Licensee, her spouse, her assistant, and eight children, whom two were infant age. 4 more children arrived shortly after. All adults present have cleared fingerprints. License was observed to be posted. There is working phone in the home. The hours of operation are Monday through Friday 7AM to 5PM. LPA toured in the inside and outside of the home. The off-limit areas inside of the home are storage/office room, the entire second floor, and garage. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA reminded Licensee that anything that states to keep out of reach of children needs to inaccessible, such as diaper cream. There are age appropriate toys and equipment for children. There were no baby bouncers observed during today's inspection. Each child has their own individual play yard. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 02/2022. Licensee stated that there are no weapons, such as firearms, stored in the home. Licensee does have a pet. The backyard is used. The off-limit areas outside of the yard are the left side of the yard and the wrap around porch. There is a fence that goes around the backyard. Licensee has gates to block any area that is open to the side yard and the wrap around porch. Play equipment were observed to be safe. There were no bodies of water observed during today's inspection. --------------------------continues on 809 dated 05/05/2022 page 2-------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: ARRIOLA, DENISE	FACILITY NUMBER: 434413542
	VISIT DATE: 05/05/2022

NARRATIVE

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--------------------------continuation of 809 dated 05/05/2022 page 1----------------------------

LPA reviewed documentation of sleep log for children under 2 years old. LPA 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Licensee does transport children and understands that children cannot be left alone and unattended in parked vehicles.

A copy of the facility roster was obtained. 6 children's files were reviewed. The records reviewed include but not limited to parent's rights, immunization records, and LIC 9227: Individual Sleeping Plan. LPA reminded Licensee to make sure facility name is written on LIC 624: Consent of Emergency Medical Treatment.

Licensee, her spouse, and her assistant's files were also reviewed during today's inspection. Licensee and her spouse's CPR/1st Aid expires on 02/09/2024 and her assistant's CPR/1st Aid expires on 02/22/2024. Licensee, her spouse, and her assistant

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SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: 05/05/2022

NARRATIVE

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--------------------------continuation of 809 dated 05/05/2022 page 2----------------------------

completed the Mandated Reporter training. Licensee and her spouse completed the training on 03/19/2021 and her assistant completed it on 04/2021. Her husband and her assistant have immunization records for measles and pertussis. Licensee has her immunization record for measles, but not does not have it for pertussis. Licensee stated that she will check with her doctor and send to proof to Licensing upon obtaining a copy of record.

The adults 18 and over living in the home are Licensee and her spouse. Licensee has three minor children. All adults have cleared criminal record, child abuse, index, or exemption, and TB clearance. 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.

An updated LIC 279B was obtained during today's inspection.

As a result of this inspection, no deficiencies were cited. Exit interview conducted and report was reviewed with the licensee Denise Arriola.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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