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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413957
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:55:03 PM

Document Has Been Signed on 10/11/2022 02:55 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:AGUIRRE MEDINA, BELEN & AGUIRRE, VIRIDIANAFACILITY NUMBER:
444413957
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Belen Aguirre MedinaTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Belen Aguirre Medina, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. The family child care home is located at 327A which is located behind 327B off of a side alleyway. Upon arrival, there were 5 children (3 preschool-age/2 infants), the Licensee, and Assistant (Nayeli) present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. The facility works with Pajaro Valley Unified School District and Go Kids. Hours of operation for the facility are Monday – Friday, 6:00AM-6:00PM.

Licensee states that adults, over the age of 18, residing in the home are: herself, her sister (Viridiana), and her father (Narciso). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508).

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.

LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 9/21/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher (last serviced: 10/2021), functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: AGUIRRE MEDINA, BELEN & AGUIRRE, VIRIDIANA
FACILITY NUMBER: 444413957
VISIT DATE: 10/11/2022
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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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home: attached garage and entire second floor. There is a small open-faced heater in the home that is properly barricaded. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Drinking water is readily available for children in the facility via water dispensers and water bottles. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone (cellphone) in the facility. Stairs are barricaded appropriately to keep day care children safe.

The backyard area of the home was inspected and observed to be fenced in. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: green house and storage room. No outdoor bodies of water were observed during todays inspection. There is a functioning sink located outside for children to wash hands. LPA observed a properly maintained sandbox, bikes/cars, and various activities for children to engage in outside. The Licensee states that an overhang was installed on the home for children to be able to play outside in various weather conditions as it has more space available for the children to play than in the home.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 3 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: AGUIRRE MEDINA, BELEN & AGUIRRE, VIRIDIANA
FACILITY NUMBER: 444413957
VISIT DATE: 10/11/2022
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5 children’s files were reviewed during todays inspection and all required documents were present, including Individual Infant Sleep Plan (LIC9227) and sleep check documentation for all infants.

The Licensee and assistant's files were reviewed and all required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 3/27/2023. The Licensee has current Mandated Reporter Training that expires on 3/22/2023 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Belen Aguirre Medina.

As a result of todays inspection, no deficiencies were cited.

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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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