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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005622
Report Date: 10/04/2022
Date Signed: 10/04/2022 11:59:05 AM

Document Has Been Signed on 10/04/2022 11:59 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ARGUEDAS PASARA, PAMELAFACILITY NUMBER:
214005622
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/04/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Pamela Arguedas PasaraTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, LPA Yee conducted a pre-licensing inspection today. LPA met with the applicant, Pamela Arguedas Pasara. LPA Yee and Pamela tour the entire house for health and safety hazards. Current residents are Pamela, her husband, and their 16 years old son. Their 19 years old daughter moved out. Days and hours of operation: Monday to Friday between 7:30 AM to 5:30 PM.

Day Care Areas: living room, and hallway bathroom. Off-limit areas: bedroom #1, bedroom #2, master bedroom, bathroom inside the master bedroom, family room, dining room kitchen, garage, and backyard. The home is leased. The lease agreement is on file. The home is equipped with a carbon monoxide detector, smoke detector, and fire extinguisher that meets the fire department standard. LPA advised them to conduct emergency drills once every six months and keep a log sheet.
The applicant has the required immunization records on file. CPR and 1st aid are current until 08/20/2024. The facility does not have a body of water such as a swimming pool, or hot tub. Discipline policy was discussed. The facility will provide morning snacks, lunches, and afternoon snacks.

LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. AB 1207 certificate for the applicant is on file. The Child Abuse Mandated Reporter Training was completed on 11-04-2021.

The incidental Medical Services (IMS) policy was discussed. This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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)/(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
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ARGUEDAS PASARA, PAMELA
FACILITY NUMBER: 214005622
VISIT DATE: 10/04/2022
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The 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, before 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 discussed the safe sleep regulations with the applicant 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 the 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.

LPA reviewed with the 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.
Individual Infant Sleeping Plan (LIC9227) form was discussed and provided. When the infant is napping, it needs to be checked every 15 mins and documented on a log sheet. A sample log sheet was explained and provided. Technical support for COVID was discussed. Website for forms and regulations: www.ccld.ca.gov.

A capacity worksheet was explained and provided.

Prior to licensure:

8 hours Health and Safety certificate is needed.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC809 (FAS) - (06/04)
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