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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444411913
Report Date: 02/19/2025
Date Signed: 02/19/2025 02:51:58 PM

Document Has Been Signed on 02/19/2025 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ARREOLA-FLORES, MARIANAFACILITY NUMBER:
444411913
ADMINISTRATOR/
DIRECTOR:		ARREOLA-FLORES, MARIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 431-0490
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/19/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Mariana Arreola-FloresTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At 12:10PM, Licensing Program Analyst (LPA) Angela Luz and Licensing Program Manager (LPM) Belinda DeVall met with Licensee Mariana Arreola-Flores to conduct an unannounced REQUIRED - 3 YEAR inspection. Present for this inspection was 4 infants, 8 preschool aged children, and 2 fingerprint cleared staff. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday – Friday 7AM – 4:30PM.

Facility:
The OFF LIMIT AREAS are the living room, dining room, kitchen, 2 bedrooms on the ground floor, bathroom next to the bedrooms, laundry room, garage, shed in the backyard, and entire second floor. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. Children are escorted through the living room and dining room during drop off and pick up times by their parent or authorized representative to go to and from the day care area. Licensee was reminded that when children are utilizing the living room and dining room, they need visual supervision otherwise the area will need to be placed on limits. There is a screened fireplace in the living room. The home is neat and clean with heating and ventilation for safety and comfort. The ISOLATION AREA is the library in the day care area. The outdoor play area is free from defects or dangerous conditions and is fully fenced. There is a large play structure in the backyard that is secured to the ground. There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds. There are no bodies of water. All hazardous materials and toxins are kept out of the reach of children. Licensee states that there are no firearms in the home. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. There is no service tag on the fire extinguisher.

***Page 1 of 4***
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ARREOLA-FLORES, MARIANA
FACILITY NUMBER: 444411913
VISIT DATE: 02/19/2025
NARRATIVE
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Care and Supervision: There are ample age-appropriate toys that appear to be safe and in good condition. Licensee uses talking with the child as a form of discipline. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, interference with eating, intimidation, or other actions of a punitive nature. Children are treated with dignity, receive safe, healthful, and comfortable accommodations. Licensee understands how to report Unusual Incidents/Injuries.

Records: The Licensee CPR and First Aid certificate is current and expires 1/27/26. Licensee Mandated Reporter Training for Child Care Providers expired on 11/27/24. Licensee was reminded of Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. The Licensee conducts and documents fire and disaster drills every six months, last drill was on 11/1/24. Entrance checklist for Family child care home was provided and licensee was reminded of documents to be posted in a prominent, publicly accessible area of the facility. Licensee does not transport children.

LPA reviewed six (6) children files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization records. Documentation of infant sleep checks every 15 minutes that notate any signs of distress were missing. Licensee was reminded to check on sleeping infants ages 0-24 months every 15 minutes and notate any signs of distress. Licensee understands that LIC 9227 Individual Infant Sleep Plan is required for infants 0-12 months.

LPA, Luz reviewed three (3) staff (S1-S3) files for the following records: Employee rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), immunization records, and required training. S1 and S2 are missing documentation of required immunizations, and proof of negative TB test. S2 is missing mandated reporter training. LPA reminded Licensee that personnel files are required to be maintained and kept up to date.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
***Page 2 of 4***
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ARREOLA-FLORES, MARIANA
FACILITY NUMBER: 444411913
VISIT DATE: 02/19/2025
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Mariana Arreola-Flores confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 1/7/25.

***Page 3 of 4***
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 02/19/2025 02:51 PM - It Cannot Be Edited


Created By: Angela Luz On 02/19/2025 at 02:11 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: ARREOLA-FLORES, MARIANA
FACILITY NUMBER: 444411913

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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By plan of correction due date 3/7/25, Licensee will submit proof that current fire extinguisher was serviced.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/19/2025
Plan of Correction
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By plan of correction due date 3/19/25, Licensee will submit proof of current mandated reporter training for S2-S3.
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:Belinda Devall
LICENSING EVALUATOR NAME:Angela Luz
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 02/19/2025 02:51 PM - It Cannot Be Edited


Created By: Angela Luz On 02/19/2025 at 02:11 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: ARREOLA-FLORES, MARIANA
FACILITY NUMBER: 444411913

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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By plan of correction due date 3/7/25, Licensee will submit proof of required immunizations for S1 and S2.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Belinda Devall
LICENSING EVALUATOR NAME:Angela Luz
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ARREOLA-FLORES, MARIANA
FACILITY NUMBER: 444411913
VISIT DATE: 02/19/2025
NARRATIVE
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During today's inspection, 3 Type B deficiencies are issued on attached page 809-D.
  • Current mandated reporter training certifications missing for S2-S3
  • Required immunizations missing for S1 and S2
  • Service tag missing from fire extinguisher
1 advisory note is issued.
  • Documentation of 15 minute sleep checks for infants 0-24 months.

Appeal rights were provided.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Mariana Arreola-Flores.

***Page 4 of 4, End of Report***
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7