444411913-2-12-2020-07-CC-SYIP-BLQPUR-20200212103800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444411913
Report Date: 02/12/2020
Date Signed: 02/12/2020 10:38:14 AM

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:	ARREOLA-FLORES, MARIANA		FACILITY NUMBER:	444411913
ADMINISTRATOR:	ARREOLA-FLORES, MARIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 431-0490
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	14	CENSUS: 11	DATE:	02/12/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Mariana Arreola-Flores		TIME COMPLETED:	10:50 AM

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 annual random inspection. LPA met with Licensee Mariana Arreola-Flores and explained the reason for the inspection. Present during the inspection were Licensee, two Assistant, and 11 children, whom one (1) was infant age. All adults present have cleared criminal record and child abuse index clearance. License and Emergency Disaster Plan was observed to posted. LPA discussed required posting with Licensee, such as the Notification of Parent's Rights. There is a working phone in the home. LPA toured the inside and outside of the home with Licensee. The off-limit area of the home are the entire upstairs, the two bedrooms and bathroom on the first floor, the garage, the storage, shed, deck, and chicken coop. LPA reminded Licensee that any area that is off-limit is barricaded or the door is closed, such as the bathroom on the first floor. Licensee stated that the kitchen and dining room is temporary off-limits. There are stairs in the home, which is adjacent to the kitchen. The stairs were not barricaded. Licensee is currently remodeling her home and is putting up the railing for the stairs. Licensee understands that the stairs need to be barricaded. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be stored inaccessible to children. LPA reminded Licensee that any cleaning supplies, disinfectant sprays, and diaper cream should be stored inaccessible to children. LPA observed restroom for children's use. LPA observed that there is sufficient amount of toys for children in care. ----------------------continues on 809 dated 02/12/2020 page 2------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: ARREOLA-FLORES, MARIANA	FACILITY NUMBER: 444411913
	VISIT DATE: 02/12/2020

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
26
27
28
29
30
31
32

-------------------------continuation of 809 dated 02/12/2020 page 1------------------------------

There no baby walkers observed during today's inspection. LPA observed that there is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 04/05/2019. Licensee understands that fire/disaster drill need to be conducted every 6 months and documented. Licensee stated that there are no weapons, such as firearms, stored in the home. Licensee does have pets in the home.

The backyard is used and is fenced. There is play structure in the backyard, which is anchored to the ground. LPA discussed with Licensee about her plans for the wooden pallets on the ground. She stated that she is going to throw it out. LPA also reminded to ensure that any sheds are locked. There were no bodies of water observed during today's inspection.

Licensee stated that she does not transport children at this time, but understands that children cannot be left alone and unattended. Licensee does go on walks with the children. Licensee stated that she currently does not have children in care who requires Incidental Medical Services (IMS).

A copy of the facility roster was obtained. 5 children's files were reviewed during today's inspection. The records reviewed include but not limited to Identification and Emergency Information and parent's rights. LPA reminded Licensee to check all forms are signed and dated.

Licensee and her Assistants' files were also reviewed. The records reviewed include, but not limited to the Mandated Reporter Training, immunization records, and TB test. Licensee has completed the Mandated Reporter Training on 03/2019. Licensee stated that her assistances will be taking the in-person Mandated Reporter Training on 02/25/2020 and

---------------------------continues on 809 dated 02/21/2020 page 3--------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

Page: 2 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: ARREOLA-FLORES, MARIANA	FACILITY NUMBER: 444411913
	VISIT DATE: 02/12/2020

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
26
27
28
29
30
31
32

-----------------continuation of 809 dated 02/12/2020 page 2--------------------------------------

03/31/2020. Licensee understands the requirement for an assistants, such as the TB test and immunization records for measles and pertussis. Licensee stated that she will obtain a copy of S-1's TB test and S-2's immunization records for measles and pertussis. Licensee will send a copy to Licensing office.

The adults living in the home are Licensee and her spouse. All adults have cleared criminal record, child abuse index, and TB test. 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.

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.

As a result of this inspection, a type B deficiency has been cited. An exit interview, where this report, citation, plan of correction, and appeal rights were discussed and provided to Licensee. A notice of site visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

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: ARREOLA-FLORES, MARIANA	FACILITY NUMBER: 444411913
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/21/2020 Section Cited	1 2 3 4 5 6 7	Operation of Family Child Care Home. Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evident by:
	8 9 10 11 12 13 14	Based on record review, Licensee did not conduct a fire/diaster drill within the past 6 month. The last fire/disaster drill was conducted on 04/15/2019. This poses a potential 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: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4