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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423986
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:12:44 PM


Document Has Been Signed on 08/23/2024 04:12 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ARCHUNDIA, ERIKAFACILITY NUMBER:
013423986
ADMINISTRATOR:ARCHUNDIA, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 355-2857
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:14CENSUS: 0DATE:
08/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Erika ArchundiaTIME COMPLETED:
04:25 PM
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On August 23, 2024, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced prelicensing inspection. LPA met with applicant Erika Archundia. The applicant lives in the home with her minor son. LPA toured the home for a health and safety check. The applicant plans to care for ages 3 months - 12 years old, and operate on Monday - Friday, 7:30am - 5:30pm.

The home is a single family house consisting of three bedrooms, one bathroom, a garage, and a fully fenced in backyard.

The Off Limit Areas are the kitchen, the bedroom to the right of the bathroom, and the bedroom next to the kitchen, the garage (will only be used for the children to walk through to go to the backyard), and the storage room in the backyard. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.


The On Limit Areas are the living room, dining room, bathroom, the middle bedroom, and the backyard.
Isolation Area - the middle bedroom

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. The main daycare area is the living room and the middle bedroom will be used as the nap/isolation room. LPA did not observe any medication, bodies of water, or poisons accessible to children during the inspection today. Per applicant there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a working combined smoke and carbon monoxide detector in the living room. The applicant's CPR certificate expires February 2025. The applicant's Mandated Reporter certificate for General training expires 8/19/2026. The applicant plans on utilizing the backyard for outdoor play. The home has a central heating system, there was not a wall heater or a fire place in the home.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ARCHUNDIA, ERIKA
FACILITY NUMBER: 013423986
VISIT DATE: 08/23/2024
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LPA reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children. LPA left copies with the applicant. LPA advised the applicant of where to obtain additional copies of the forms. Applicant was reminded that the required documents must be visible for the public at all times during hours of operation. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPA reviewed children's personal rights and the applicant confirmed that she understands that children's personal rights should not be violated and no corporal punishment is allowed. LPA reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPA reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing 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) or (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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ARCHUNDIA, ERIKA
FACILITY NUMBER: 013423986
VISIT DATE: 08/23/2024
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

On August 23, 2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The applicant owns the home and has provided proof of control of property.



Before a License is issued the following shall be complete:
- Oakland Regional Office needs to receive the fire clearance from the Berkeley Fire Department
- Send the LPA a Mandated Reporter Certificate for Childcare Providers
- A photo of the complete parent board

Exit interview conducted. Report reviewed and provided to Applicant Erika Archundia.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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