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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213578
Report Date: 06/06/2022
Date Signed: 06/06/2022 05:05:05 PM

Document Has Been Signed on 06/06/2022 05:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ARREDONDO FAMILY CHILD CAREFACILITY NUMBER:
426213578
ADMINISTRATOR:SILVIA ARREDONDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 349-7743
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 7DATE:
06/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Silva Arredondo TIME COMPLETED:
05:15 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 06/06/2022 at 1:30 P.M. Licensing Program Analyst (LPA), Martina Jimenez, conducted an unannounced Annual Required Inspection and met with Silvia Arredondo, Licensee, Julissa Diaz Arredondo, Assistant/daughter, and Cassandra Diaz, daughter. The purpose of the inspection was explained, and together the home was toured inside and out. All required forms are posted in a prominent location. LPA observed 2 -infants and 5 children napping in the living room and the family care room.

The main day-care areas are the living room, family room, day-care room, dining room, kitchen and hallway bathroom. LPA observed age appropriate toys and books in the indoor activity area. The bathroom used by children was observed to be clean and free of toxins. The bedrooms and garage are secured with gates and chain locks making them off limits to day care children. All hazardous items are stored inaccessible to children in care. LPA observed playhouses, play kitchen and small climbing structures, tricycles, tables and chair age appropriate for children. The backyard is completely fenced.

No bodies of water were observed. Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. The fire extinguisher was observed at 1:40 PM to have been serviced 05/24/ 2022. Licensee was reminded to service or replace the fire extinguisher yearly. There is a functioning carbon monoxide detector and smoke alarm were tested at 2:13 PM, that meets statutory requirements.

Licensee and assistant are current with immunization required per SB 792. The last Safety drill was conducted 01/07/2022. Licensee and assistant are current with CPR and First Aid which expires 10/23/2022. Continued on LIC 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578
VISIT DATE: 06/06/2022
NARRATIVE
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The Mandated Reporter Training was completed on 8/7/2020. Facility roster and a sample of children's records were reviewed at 2:43 PM. The files of child #1 and child #2 were missing Individual Infant Sleeping Plan (LIC 9227), and documentation of infants sleep time of each 15 -minute check.

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: www.ada.gov/childqanda.htm



LPA reviewed and provided Licensee with Safe to Sleep (PIN 20-24-CCP-SP), LIC 9227, Safe Sleep Chart, and "What is Lead." LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12, Spanish, Appeal rights given. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/06/2022 05:05 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/06/2022 at 04:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview of licensee and record review, the licensee did not comply with the section cited for child #1 and Child #2 were missing Individual Infant Sleeping Plan (LIC 9227) from files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Licensee will submit verification of LIC 9227 for child #1, child #2 and submit a written statement on how licensee will prevent future incidents.
Type B
Section Cited
CCR
102425(c)(1)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview of licensee and record review, the licensee did not comply with the section cited for child #1 and Child #2 were missing Individual Infant Sleeping Plan (LIC 9227) from files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Licensee will submit verification of LIC 9227 for child #1, child #2 and submit a written statement on how licensee will prevent future incidents.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/06/2022 05:05 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/06/2022 at 04:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview of licensee and record review, the licensee did not comply with the section cited for child #1 and Child #2 were missing Individual Infant Sleeping Plan (LIC 9227) from files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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3
4
Licensee will submit verification of LIC 9227 for child #1, child #2 and submit a written statement on how licensee will prevent future incidents.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview of licensee and record review, the licensee did not comply with the section cited for child #1 and Child #2 files were missing time of each 15-minute check, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Licensee will submit a written statement on how licensee will prevent future incidents.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022


LIC809 (FAS) - (06/04)
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