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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413957
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:50:47 AM

Document Has Been Signed on 08/09/2023 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:AGUIRRE MEDINA, BELEN & AGUIRRE, VIRIDIANAFACILITY NUMBER:
444413957
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
08/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Belen Aguirre MedinaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Belen Aguirre Medina, to conduct case management visit for capacity increase to a large family child care home (FCCH). Upon arrival, LPA was admitted into the home by Belen and toured both indoors and outdoors during today's inspection.

Fire clearance was approved for the home by Watsonville Fire Department on 7/27/2023. The Licensee states that adults, over the age of 18, residing in the home is herself, her sister (Viridiana Aguirre) and her father (Narciso Aguirre Vasquez). There are three minor children additionally living in the home. Off-limits inside the home include: entire second floor and one bedroom. All other areas in the home will remain on-limits and unchanged from the small family child care home limitations. The Licensee states that she works with Community Bridges Food Program and serves the children breakfast, lunch, and AM/PM snack. The Licensee additionally states that she works with Go Kids, Pajaro Valley Unified School District, and CalWorks subsidy programs. The home is equipped with a 3A40BC fire extinguisher (last serviced 10/2022) functioning smoke detector and carbon monoxide detector. The last emergency disaster drill was conducted on 8/3/2023, which is compliant with the six month requirement for homes. There are sufficient toys and materials that are age-appropriate and safe for children.

LPA toured outside of the home and observed it is fenced in for children. Off-limits outside of the home include: two storage rooms and carport area. Shade is provided for the children by home building overhang and outside the children have plastic structures, a sandbox, various activity zones, bikes, and plastic vehicles to play with. There were no bodies of water observed during today's inspection.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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: 08/09/2023
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LPA reviewed large FCCH capacity with the Licensee, Belen, and she understands that whenever an assistant is not present, she shall follow capacity requirements for a small FCCH. LPA advised that a large FCCH may care for more than 12 children and up to and including 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age. LPA provided the Licensee with large FCCH capacity reference sheet as well as copy of Section 102416.5 Staffing Ratio and Capacity. LPA advised that an assistant must be older than 14 years old and shall have all required documentation on file such as proof of immunizations (MMR, Tdap, flu), negative tuberculosis (TB) test, Mandated Reporter training for child care providers, and all Licensing paperwork. If an assistant is less than 18 years old, the assistant must receive Criminal Record Clearance through DOJ, FBI, and CACI within 30 days of turning 18. LPA additionally advised an assistant under the age of 18 shall not be left alone with day care children at any time. LPA advised an assistant over the age of 18 shall remain alone with the children, however must have proof of pediatric First-Aid/CPR.

As a result of today's inspection, no deficiencies were cited.

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

LPA advised that a license for a large FCCH will be issued following manager review and approval.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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