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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416046
Report Date: 10/24/2022
Date Signed: 10/24/2022 04:07:06 PM

Document Has Been Signed on 10/24/2022 04:07 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BARRERA, MILTONFACILITY NUMBER:
434416046
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
10/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Milton BarreraTIME COMPLETED:
04:15 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
Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Milton Barrera to open a complaint investigation for the above allegation. Present were licensee, helper Zoila Lopez and three day care infant.

Upon arrival, there was no answer at the door. LPA observed man walk up to the facility who was later identified as licensee Milton Barrera. Milton stated he went to help his neighbor who is day care provider Zoila Lopez. Zoila was caring for the children in Milton's home while he went to her home. Zoila Lopez is not associated to facility. LPA observed three infant sleeping. Two infants were sleeping in play yards with blankets hanging from the sides of play yards. LPA observed one stuff animal on top of child's back and another stuff animal near child's face inside play yard with sleeping infants.

LPA Deanna Villagrana informed licensee Milton Barrera that this report dated 10/24/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Milton Barrera to provide a copy of this licensing report dated 10/24/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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
Document Has Been Signed on 10/24/2022 04:07 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/24/2022 at 03:38 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BARRERA, MILTON
FACILITY NUMBER: 434416046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2022
Section Cited
CCR
102370(d)(2)

1
2
3
4
5
6
7
102370(d)(2) Criminal Record Clearance. Prior to working, or volunteering in a licensed home, all licensees and personnel as specified shall request a transfer of a criminal record clearance as specified in Section 102370 (j).
1
2
3
4
5
6
7
Milton understands that all adults living or working with day care children in the home must be associated to the facility roster. Milton will associate Zoila Lopez in the future.
8
9
10
11
12
13
14
This requirement was not met as evidenced by Zoila was caring for the children in Milton's home while he went to her home. Zoila Lopez is not associated to facility. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/24/2022 04:07 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/24/2022 at 03:42 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BARRERA, MILTON
FACILITY NUMBER: 434416046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2022
Section Cited
CCR
102425(b)

1
2
3
4
5
6
7
Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by LPA observed one stuff animal on top of child's back and another stuff animal near child's face inside play yard with sleeping infants.
1
2
3
4
5
6
7
Licensee removed items during visit. Deficiency cleared today.
8
9
10
11
12
13
14
This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
10/24/2022
Section Cited
CCR102425(b)(3)

1
2
3
4
5
6
7
There shall be no objects hanging above or attached to the side of the crib. This requirement was not met as evidenced by Two infants were sleeping in play yards with blankets hanging from the sides of play yards.
1
2
3
4
5
6
7
Licensee removed items during visit. Deficiency cleared today.
8
9
10
11
12
13
14
This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14
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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 3 of 3