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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500492
Report Date: 09/28/2021
Date Signed: 09/28/2021 02:51:27 PM

Document Has Been Signed on 09/28/2021 02:51 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:AGUINIGA, ANAFACILITY NUMBER:
394500492
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Ana R Tapia AguinigaTIME COMPLETED:
03:10 PM
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On Tuesday, September 28, 2021 at 01:15 p.m. Licensing Program Analyst (LPA) Elvira Sierra conducted a Prelicensing inspection and met with applicant, Ana R Tapia Aguiniga. LPA explained about obtaining $300,000 liability insurance. Facility hours of operation will be M-F 07:00 a.m. to 06:00 p.m. All adults residing in the home have obtained a criminal record clearance.

At 01:45 p.m. a health and safety inspection was conducted and the following was observed. Home is a 3 bedrooms and 2 bathroom single story home. The Off-limits areas include; Bedroom # 2, # 3 (master bedroom), Bathroom #2 inside master bedroom, Kitchen, hall closet, Laundry room, garage, front yard, left and right side area of the backyard and driveway. Applicant acknowledged that children may never enter these off-limit areas. The home is equipped with at least one working carbon monoxide and a smoke detector. LPA observed a fully charged fire extinguisher that meet minimum size requirements. Also sharp utensils or knives and medications are inaccessible to children in the off limit area. Applicant stated she will provide meals. Per Applicant, there are no weapons and no bodies of water were observed on the premises. Applicant was advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed changes.

Applicant has a current CPR that expires on 5/22/2023. Mandated Reporter Training expires on 07/20/23. Applicant understands that the training must be updated every 2 years. LPA advised applicant that baby walkers, bouncers, jumpers, and similar items are not allowed in a Family Child Care Home

Report continues on page 809C----
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: AGUINIGA, ANA
FACILITY NUMBER: 394500492
VISIT DATE: 09/28/2021
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Licensee was reminded that all adults 18 and over living or working in the home, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm


LPA discussed the safe sleep regulations with Licensee 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 licensee [facility representative] 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.


Effective today, 09/28/21 applicant is approved for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

Facility evaluation report was review and a copy was provided to the Applicant.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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