434416046-5-17-2022-07-CC-SCES-CEHNWU-20220517105008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416046
Report Date: 05/17/2022
Date Signed: 05/17/2022 10:50:22 AM

Document Has Been Signed on 05/17/2022 10:50 AM - 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:	BARRERA, MILTON		FACILITY NUMBER:	434416046
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/17/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Milton Barrera		TIME COMPLETED:	11:00 AM

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 05/17/2022 at 8:55 AM, Licensing Program Analysts (LPAs) Susy Cervantes and Araceli Almaraz conducted an announced pre-licensing visit to the home. LPAs met with Milton Barrera, Applicant, and explained the nature of today's visit to them. The adults that reside in the home are the Applicant and their niece. Days and hours of operation will be Monday - Friday from 7:00 AM to 5:30 PM. Applicant has completed her Preventative Health and Safety Child Care Training on 03/09/2019 and the lead component on 03/31/2022 and a copy of completion is on file. Applicant's CPR and First Aid certifications are current and expire on 03/30/2024. Mandated Reporter Training was completed on 10/13/2021. Applicant rents the home. Applicant does not have liability insurance and will issue affidavit regarding liability insurance for FCCH, applicant stated they plan to get insurance for the daycare. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 05/17/2022 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. 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, 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. LPAs toured the indoor and outdoor areas during today's visit. LPA observed gated stairs, no wall heater and no fireplace in the home. Off limit areas: second floor, garage, shed, left and right side yards. *Continues on report dated 05/17/2022 pg. 1/3*

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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 3

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: BARRERA, MILTON	FACILITY NUMBER: 434416046
	VISIT DATE: 05/17/2022

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

Continuation of report dated 05/17/2022 pg. 2/3

LPA observed a fully charged 3A40BC fire extinguisher, working dual smoke and carbon monoxide detector, a fenced backyard, and no bodies of water. Applicant states that there are no weapons in the home and no pets. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and stored in the garage. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

Forms of discipline used by Applicant: separate and time out. Applicant understands that children's personal rights should not be violated; including no corporal punishment. A Family Child Care Home packet with updated Licensing forms was provided and reviewed with the Applicant. Department website: www.ccld.ca.gov. provided to Applicant. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting unusual incidents/injuries, suspected child abuse (Mandated Reporter training AB 1207), SB 792 (Immunization's for Measles Pertussis and Influenza) and healthy beverages in child care, 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. 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 applican 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 [applicant, licensee, or 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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BARRERA, MILTON	FACILITY NUMBER: 434416046
	VISIT DATE: 05/17/2022

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

Continuation of report dated 05/17/2022 pg. 3/3

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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 requirements of AB 633 with the Applicant and provided them the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPA also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected.

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.

Exit interview conducted in Spanish and report was reviewed with the applicant, Milton Barrera.

LPA advised applicant that Licensure for a small family child care home is granted pending the following:

- Management's approval.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3