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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401628
Report Date: 05/22/2025
Date Signed: 05/22/2025 04:48:59 PM

Document Has Been Signed on 05/22/2025 04:48 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PAEZ, BLISSFACILITY NUMBER:
073401628
ADMINISTRATOR/
DIRECTOR:		PAEZ, BLISSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 234-0539
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
05/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Bliss PaezTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
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On 05/22/2025 at 1:45 PM Licensing Program Analysts (LPAs) A. Hollinger and K. Sykes conducted an unannounced Annual Required inspection at Bliss Paez Family Childcare Home. LPAs met with Licensee and explained the purpose of today's inspection. LPAs were granted the inspection authority to enter the Home. The hours of operation are Monday through Friday 6:00 AM to 6:00 PM. Present in the home at time of inspection were Licensee, Licensee's spouse, and Licensee's aunt. There were no day care children present during today's inspection, however, the Licensee's minor children did arrive during the inspection.

A health and safety tour of inside the home was done. LPAs toured the premises with Licensee. The home is a two-story house which consists of four (4) bedrooms, three (3) bathrooms, living room, dining room, kitchen, laundry room, attached garage, backyard and sun room one (1) and two (2).



ON-LIMIT areas: the dining room, bedroom to the right of the hallway bathroom, hallway bathroom, kitchen.

OFF-LIMIT areas: the living room, 3 bedrooms (entire second story), laundry room as walkway to the backyard and backyard, and garage. The off-limit areas are inaccessible to children in care by closed, locked doors and visual supervision.

LPAs inspected the areas accessible to children to ensure that they are clean and orderly. The home is equipped with ventilation and central heating system for the safety and comfort of children in care. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children when in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

SEE LIC 809-C----------------------------------------------------------------------------------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Ashley Hollinger
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PAEZ, BLISS
FACILITY NUMBER: 073401628
VISIT DATE: 05/22/2025
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The isolation area is located in the living room on the couch.

There is a fireplace in the living room which is made inaccessible to children in care by a gate. Licensee was reminded that smoking is not allowed in a family childcare home. Licensee was reminded that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are no pets in the home. Licensee stated there are no firearms or ammunition stored in the home. There is a 3A40BC fire extinguisher and working smoke and carbon monoxide detector located throughout the home. Children files and Facility files were reviewed. Facility contained a Children's Roster and their Mandated Reporter training expires 6/3/2026: CPR and Pediatric First Aid expired on 9/2024. Licensee stated that they will complete CPR/Pediatric First Aid training and submit proof by 6/5/2025. LPAs did not observe any pools, hot tubs or other bodies of water. The last fire/disaster drill was conducted on 5/21/2025.

Licensee stated they do not use backyard for outdoor play activities. Licensee stated they use a park nearby for outdoor activity. LPAs reminded Licensee when outside of the facility, 100% supervision of children in care is required. Facility does provide transportation for children, and Licensee understands that children cannot be left alone, unattended in parked vehicles.


Licensee owns their home and provided proof of ownership. LPAs reminded Licensee that the day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page athttps://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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

SEE LIC809-C-------------------------------------------------------------------------------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Ashley Hollinger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PAEZ, BLISS
FACILITY NUMBER: 073401628
VISIT DATE: 05/22/2025
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Licensee 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, 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.

No deficiencies were cited during today's inspection.

The following was discussed:

  • Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100 or more per day per Civil Penalty.
  • LPA informed Licensee any structural changes, the Licensee must inform LPA prior to structural changes.
  • LPA informed Licensee that CPR/Pediatric First Aid training must be completed and updated every 2 years.

A Notice of Site visit was given and must remain on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Bliss Paez.

Appeal rights reviewed and were given to Licensee.

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Ashley Hollinger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
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