<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619326
Report Date: 09/20/2024
Date Signed: 09/20/2024 12:15:16 PM

Document Has Been Signed on 09/20/2024 12:15 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ARJONA, LORENAFACILITY NUMBER:
343619326
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Lorena ArjonaTIME VISIT/
INSPECTION COMPLETED:
12:15 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
On 09/20/2024 at approximately 09:45 AM Licensing Program Analyst (LPA) Loraine Perez met with, Licensee Lorena Arjona (Licensee), for an unannounced annual inspection. Present in the home was Licensee and Licensee’s adult daughter. A census of three children, one infant and two preschoolers were present. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 7:30 AM to 5:30 PM.

A health and safety inspection was conducted in the areas accessible to children. The home is a single story, three bedrooms and two bathrooms, kitchen with dining area, living room with fireplace, second living room used for child care, a fenced backyard, and garage. LPA observed a fireplace that is barricaded to meet regulation. Off limit areas include the all bedrooms and primary bathroom, garage, left and right sides of backyard. Licensee understands that children may never enter off-limits areas. LPA observed a dog in the garage. Licensee stated the dog only shares space with the children occasionally on Fridays. The dog mainly remains in the garage or fenced right side of backyard while children are in care. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 3A40BC fire extinguisher within the home. LPA observed the home was safe, orderly, and free of hazards.

LPA observed a variety of age-appropriate toys and first aid kit available in the room where care is mainly provided. Licensee stated there are no firearms or bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA observed all required postings, a children's roster and fire drill log. Last fire drill was conducted on 08/13/2024. LPA reviewed records of children’s files and staff files, all of which contained the required documentation. Licensee has current EMSA-approved pediatric CPR/First Aid which expires 12/2025 and Mandated Reporter certification which expires 01/2025. Licensee understands both CPR and Mandated Reporter training must be completed every two years. Report continues on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ARJONA, LORENA
FACILITY NUMBER: 343619326
VISIT DATE: 09/20/2024
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
26
27
28
29
30
31
32
Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA reviewed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/. No children with medications are currently enrolled.

Licensee was informed of the MyChildCarePlan.org website; 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. To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No Title 22 deficiencies are being cited based on today's inspection. Exit interview conducted and report was reviewed with Licensee Lorena Arjona. During the exit interview, Licensee Lorena Arjona confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Notice of site visit was given and must remain posted for 30 days

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2