233010158-2-15-2022-01-CC-LROS-CBNVBE-20220215151724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 233010158
Report Date: 02/15/2022
Date Signed: 02/15/2022 03:17:29 PM

Document Has Been Signed on 02/15/2022 03:17 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	ARAUZ, MELISSA FCCH		FACILITY NUMBER:	233010158
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	02/15/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Melissa Arauz		TIME COMPLETED:	03:35 PM

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	A (change of location) Pre-Licensing inspection was conducted today by Licensing Program Analyst (LPA), Leticia Rosales-Meza. The applicant is Spanish Speaking. The applicant was previously licensed at 116 Spring St., Fort Bragg, CA 95437. The applicant is requesting a license for a capacity of 8 children. Services will be available Monday - Sunday 12:00 AM - 11:59 PM. The applicant understands that 24hr consecutive care is prohibited. The applicant understand that childcare must be provided in the "primary" residence of the applicant. The residence is a three bedroom two bath home. There are currently two adults living in the main home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. During the pre-licensing inspection, LPA provided technical assistance to Applicant related to COVID-19 guidelines and self-assessment. The floor and yard plans are verified. The children will have access to the living room, kitchen, and hallway bathroom. The "off limits" areas are the three bedroom, master bathroom and garage. These areas have been made inaccessible by door knob slip covers. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. Latches are used underneath the kitchen and bathroom sinks and drawers. The applicant stated there are no Firearms or Weapons and none were observed. Applicant stated there are no poisons in the home. The requirement that poisons be stored in a space locked with a key lock/combination lock is reviewed. First Aid supplies are kept in the kitchen. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A, 10:BC. There is a wood burning stove in the living room. The wood burning stove is surrounded by a wrought iron barrier to prevent access to the children. The home is heated and cooled by a central unit. The home is heated and cooled by a central unit. The children will use half of the back yard as the outdoor play area and it is fully fenced. The children will also have access to the front yard and is fully fenced. There is no trampoline, pond, or fountain.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ARAUZ, MELISSA FCCH	FACILITY NUMBER: 233010158
	VISIT DATE: 02/15/2022

NARRATIVE

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There is an in-ground pool located in the other half of the back yard. The in-ground swimming pool is surrounded by a five foot fence. The slats are 3.5 inches apart. The fence does not obscured the pool from view. There is a self closing, self latching gate that swings away from the pool per regulation requirements. The gate has a combination lock. This area is "off limits" to the children. There is a pool house in the side yard which will be "off limits" to the day care children, which is key locked and also has a door knob cover. Applicant understands that children will be supervised at all times when using the backyard.
Incidental Medical Services (IMS) regulations were reviewed with the applicant. The applicant understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid. CPR and First Aid cards expire 08/2023. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants or children shall not be allowed to sleep in car carriers in the home. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in any area where child care is provided. The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/ Megan's Law web site was provided (http://www.meganslaw.ca.gov). The Applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

This facility meets licensing standards and is now licensed as a Small Family Child Care Home.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC809 (FAS) - (06/04)

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