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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203911380
Report Date: 01/26/2023
Date Signed: 01/27/2023 11:29:17 AM

Document Has Been Signed on 01/27/2023 11:29 AM - 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BARRAGAN, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
203911380
ADMINISTRATOR:BARRAGAN, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 780-5611
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angelica BarraganTIME COMPLETED:
07:00 PM
NARRATIVE
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On 1/26/2023 Licensing Program Analysts (LPAs), Stephanie Vega-Gonzalez and Martha De Haro conducted an unannounced Annual Required Inspection and was met by Licensee, Angelica Barragan. LPAs explained the reason for the visit and provided Licensee with business card. Also present was Assistant, Alexandra Barragan. Licensee is Spanish Speaking and LPA Vega-Gonzalez assisted with interpretation. Days and hours of operation are Monday through Saturday and open 24 hours.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the living room, dining room, hallway bathroom, bedroom #1, back yard, front yard are used for providing care and are accessible to children. During inspection Licensee requested to update Facility Sketch LIC 999 and place bedroom #2, bedroom #3, and garage as “Off-Limits”. Licensee updated Facility sketch during inspection. All other rooms are off-limits and made inaccessible by locked doors, and plastic doorknob spinners.

LPAs observed in extended backyard an above ground pool with water and ladder that does not meet pool regulations. LPAs observed Licensee unplug pool and water was being dumped out. LPAs observed that above ground pool was accessible to children in care via the back yards back gate, that does not swing away from the pool, self-close or have a self-latching device located no more than six inches from the top of the gate. LPAs measured gate to be 4 feet and 13 inches tall. LPAS observed that above ground pool is also accessible via the front yard via the side gate that was open and does not meet pool regulations. There are no firearms or ammunition on the premises.

(Continue on LIC809)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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 12
Document Has Been Signed on 01/27/2023 11:29 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/26/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that, LPAs observed various dangerous items in front yard, back yard, and extended back yard which are stated in LIC809 and LIC 809-C, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee stated that they will watch video Locks and Inaccessiblilty Requirements in Child Care, and write a statement on what they have learned. Licensee stated that they understand that front yard and back yard will be palced on off-limits. Licensee stated that they understand that they will contact CCL once items which pose a danger to children have been cleared and are inaccessible.
Type A
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that, LPAS observed an above ground pool with water and a ladder located in the extended back-yard that was accessbile to chidlren in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee stated that they will watch video, Bodies of Water Requirements in Child Care, and write a statement on what they have learned. Licensee stated they will remove above ground pool and place it in the shed, and provide CCL with images by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


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Document Has Been Signed on 01/27/2023 11:29 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/26/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, , the licensee did not comply with the section cited above in that it was reviewed that facility had not conducted a fire drill within the past six months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Licensee stated that they will conduct a fire drill and submit proof of drill to CCL by POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee and Assistant did not have current Mandated Reporter training's, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Licensee stated that both her and Assistant will complete the Mandated Reporter AB1207 and submit proof to CCL by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


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Document Has Been Signed on 01/27/2023 11:29 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/26/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee did not have Assistant's immunization's on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Licensee stated that they will update Assistant's file with the required immunization's and provide proof to CCL by POC due date.
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee did not have a file with required licensing documents for Assistant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Licensee stated that they will complete Assistant's file with required licensing documents and provide proof to CCL by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/27/2023 11:29 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/26/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that LPA observed that Child 1, Child 2, and Child 6 do not have immunization's on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensee stated that they will update Child 1, Child 2, and Child 6's immunization's and provide proof to CCL by POC due date. Licensee stated that they will watch the following video, Record Keeping in Family Child Care, and write a statement on what they have learned to CCL by POC due date.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that upon record review it that Child 5 had a incomplete file/documents and Child 6 did not have a file in facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensee stated that they will update Child 5 and Child 6's files with required licensing documents and provide proof to CCL by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
Page: 5 of 12
Document Has Been Signed on 01/27/2023 11:29 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/26/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee did not have a roster in facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensee stated that they will complete a children's roster LIC9040 and provide proof to CCL by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380
VISIT DATE: 01/26/2023
NARRATIVE
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LPAs observed the following: In BACKYARD of facility LPAs observed a one gallon white container half fluid with blue substance, a hand held saw machine, a Winchester pocket knife, two boxes of exterior screws, a propane tank connected to an North American outdoor burner/fryer, a yellow container that is 15 ½ by 13 filled with water, broken plastic garden fencing, a wet/damaged stroller, a little tike buggy with spider webs, a pink trike with water in back container, a chef knife, a pocket lighter, a white Coleman container with dog food, permanent color cream 3fl oz, a wooden handle garden lopper (garden scissors) all of which children had access to in care. LPAs observed that dining area door that leads to the backyard had a lever lock that can be easily open by older children in care. LPAs observed in EXTENDED BACKYARD the following: An above ground pool with water and ladder that does not meet pool regulations, two sheds in the fenced extended back yard were not locked and accessible to children in care via a side front gate. LPAs observed the following: motor oil lawn mower, various nails, various working equipment, metal containers, red portable oil container, lighter fluid, bed bug killer, waterproof seal DAP. LPA observed in the FRONT YARD the following: On left-side of the house a Duralast car battery, ZEREX Valvoline antifreeze coolant, broken toddler slide, broken baby swing, various broken wood planks, a computer monitor with cables, loose glass panels, by side gate LPA observed loose wooden planks with splinters, 4 broken bed post with exposed screws, 4 broken wooden bed headboards, a parked car with damaged car hood with exposed car part, and playground equipment with screws.

The BACKYARD AND FRONT YARD HAS BEEN MADE “OFF-LIMITS” effective today. Licensee understands that the backyard and front yard must be inspected and licensed for use prior to allowing children access.

LPA observed 5 small dogs. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets. The fireplace located in the living room and is made inaccessible by a zip tie. LPA reviewed fireplace regulations with Licensee. Licensee stated that fireplace will not be in use during daycare hours. LPA did not observe an electric fireplace in living room that was hung on the wall. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. LPA did not observe any stairs in this home. The home has working telephone service and LPA confirmed the phone number is (760) 780-5611.

(Continue on LIC809)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380
VISIT DATE: 01/26/2023
NARRATIVE
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LPAs did not observe any infants in care during inspection. Licensee sated that they are not currently caring for any infants. LPA discussed Safe Sleep Regulations with licensee. LPA observed one crib and a play yard in facility. LPA observed various toys inside play yard. Licensee understands that crib and play yard must be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. License stated that infants are not swaddled while in care. Licensee understands that they must conduct physical checks on sleeping infants every fifteen minutes and document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee does not have a current roster of the children. An emergency fire/disaster drill had not been completed and documented within the last 6 months. Last fire/disaster drill was conducted on 6/7/2021. Licensee’s Mandated Reporter Training was completed on 09/24/2020. Licensee’s pediatric CPR/First Aid expires on November 2, 2022. Assistant’s does not have a Mandated Reporter Training on file. Assistant completed a CPR/First Aid training that is not pediatric that expires on 1/8/2024. A review of records indicates that Licensee had immunization records on file for influenza, pertussis and measles. A review of records indicates that Assistant had no immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



(Continue on LIC809)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380
VISIT DATE: 01/26/2023
NARRATIVE
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Licensee Angelica Barragan 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, 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.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

LPA discussed the safe sleep regulations with Licensee Angelica Barragan 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 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 infants devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process



Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

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. Exit interview conducted and report was reviewed with the facility representative Licensee Angelica Barragan

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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