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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417687
Report Date: 07/19/2023
Date Signed: 07/19/2023 02:35:39 PM

Document Has Been Signed on 07/19/2023 02:35 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BIRRUETE-ALVAREZ, ALEJANDRAFACILITY NUMBER:
274417687
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Alejandra Birruete AlvarezTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced pre-licensing inspection to the home today. LPA met with Alejandra Birruete Alvarez, applicant, and explained the nature of today's inspection to her. Applicant has been licensed before at 1053 Paseo Grande #19, Salinas, CA 93905 with license #274415877 and has requested a change of location. Applicant states that herself, her spouse Francisco, and her adult children Francisco and Esmeralda are the only adults residing in the home. Applicant states that her minor 15 years old daughter also resides in the home.
Days and hours of operation will be Monday to Saturday from 4:00 AM to 12:00 AM. Applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training on 6/23/23. Applicant's pediatric CPR and First Aid certifications are current and will expire on 2/18/25. Applicant owns the home and a copy of a document from the Title Company is in file. Applicant states does not have liability insurance for a family child care home (FCCH) and will use the Affidavit regarding liability insurance for Childcare (form LIC 282).
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed there are not wall heaters in the home. LPA observed there are not bodies of water in the home. LPA observed there are barricaded stairs inside the home. Off limit areas inside the home: All the second floor, the family room, the laundry room, and the garage. LPA observed applicant has a 3A40BC fire extinguisher in the home, and at least one working smoke detector. LPA observed the home currently does not have a working carbon monoxide detector. Off limits outdoor areas are: The right and the left side yards, and an storage shed located in the right side yard. Applicant will use the back yard as playground for the children in care. LPA observed the back yard is fenced. Applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. LPA observed the applicant has three small breed dogs, applicant stated the dogs are vaccinated, and will be kept in the off limits areas of the home during the time the children in care are present.
Applicant understands that prior to make any change related to the on or off limits must be reported to Licensing Program.
********************* Report dated 7/19/23 continues on page 2 ***************
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BIRRUETE-ALVAREZ, ALEJANDRA
FACILITY NUMBER: 274417687
VISIT DATE: 07/19/2023
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*******Report dated 7/19/23 continues from page 1.
Applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children.
LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.
Forms of discipline applicant will use: Communication with children and redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options for a small license, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Department website www.cdss.ca.gov provided to applicant.
LPA observed proof of immunization for measles, pertussis and an opt out note for influenza are in the applicant's file.
A review of staff records on 7/18/23 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Applicant understands that her adult daughter Ruby who has a criminal records clearance needs to be associated to this facility number.
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.The applicant provided proof of control of property. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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. Review of records to be maintained - Child Care Centers

Report dated 7/19/23 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BIRRUETE-ALVAREZ, ALEJANDRA
FACILITY NUMBER: 274417687
VISIT DATE: 07/19/2023
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*******Report dated 7/19/23 continues from page 2.

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.

LPA discussed the safe sleep regulations with applicant and, discussed the Child Care Licensing Safe Sleep web page 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 the date, 6/19/23 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 addresses. 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.

Exit interview conducted and report was reviewed with the applicant Alejandra Birruete Alvarez.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant was informed that an small Family Child Care Home license will be approved pending on the following: 1) submit proof of installing a Carbon Monoxide detector, 2) Associate her adult daughter Ruby by submitting a signed Form LIC9182, and 3) Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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