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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622688
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:03:53 PM

Document Has Been Signed on 11/04/2022 03:03 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ARAMBULA, JOHANA ELIZABETHFACILITY NUMBER:
393622688
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Johana ArambulaTIME COMPLETED:
03:30 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 11/04/2022, Licensing Program Analyst Katy Maestas (LPA1) and Licensing Program Analyst Corina Beckby (LPA2) conducted a field visit to the Family Childcare Home (FCCH) for the purpose of a case management inspection. LPAs arrived at the FCCH and was met by Licensee Johana Arambula (L1). Also present in the FCCH was L1's husband. LPA1 determined, through accessing Guardian, that all required adults were background cleared. LPA1 disclosed the purpose of the inspection and was granted entrance into the FCCH. LPA1 and LPA2 toured the FCCH in all areas accessible to children. L1 accompanied LPA1 and LPA2 for the entirety of the tour. LPA1 observed 4 children during nap time. LPA1 verified that toxic and hazardous items were inaccessible to children in care. LPA1 observed a baby-gate on the stairs and a glass barricade on the fireplace. LPA1 did not observe any pool, spa nor water feature. LPA observed 1 small dog; L1 stated that the dog is the only pet in the FCCH.

L1 has requested an increase in capacity from 8 to 14 children. A fire clearance, dated 10/04/2022, has been received by LPA1 and is on file with the department. The OFF-limits areas of the FCCH include the garage, laundry room, bedroom on the 1st floor, the entire 2nd floor of the FCCH, and the dog run on the side of the home. LPA1 updated the LIC 999 Facility Sketches, reviewed the LIC 610A, and discussed ratios for a large capacity including documents required for staff or adult assistants.

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 platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Continued on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ARAMBULA, JOHANA ELIZABETH
FACILITY NUMBER: 393622688
VISIT DATE: 11/04/2022
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
L1 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, 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.

Effective today, 11/04/2022, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants OR a capacity of 14 children (when there is an assistant present) with 1 child in Kindergarten or Elementary School and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, the facility reverts back to the capacity regulations of a small family childcare license.



In the areas that were evaluated, no deficiencies were observed at the time of the visit. An exit interview was conducted, and the report was reviewed with L1. Licensee Appeal Rights were provided. A Notice of Site visit was posted by LPA1 and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2