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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416796
Report Date: 10/11/2022
Date Signed: 10/11/2022 11:44:20 AM

Document Has Been Signed on 10/11/2022 11:44 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:VARGAS, ARACELIFACILITY NUMBER:
444416796
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Araceli VargasTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Applicant, Araceli Vargas, for pre-licensing inspection to ensure home is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA was admitted into the home by Applicant and toured inside and outside of the family child care home (FCCH).

Applicant states that additional adult over the age of 18 residing in the home is her son, Alexander. The hours of operation for the FCCH will be Monday-Friday 7:00AM-6:00PM and Applicant is planning to work with the Community Bridges food program. Applicant has submitted proof of residency for the home and is planning to obtain liability insurance for the day care. LPA advised Applicant to complete Affidavit Regarding Liability Insurance (LIC282) with enrolled families if she does not obtain liability insurance or chooses not to renew in the future.

Applicant 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 toured inside the home and observed areas of the home that will be used for day care. Applicant states that she will be receiving additional materials from her mother, who also runs a FCCH, such as napping cots and additional furniture/toys. LPA requested that Applicant reach out when materials have been added to the home for additional inspection. Off limits inside of the home are: two (2) bedrooms, one (1) bathroom, living room, and kitchen. The home is orderly and safe for day care children. There is a fireplace located in the living room that is off-limits to children. LPA advised Applicant that doors to off-limits areas should remain closed while children are in care or that baby gates can be used as well. There is a working phone (cellphone) at the facility. Applicant 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)
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: VARGAS, ARACELI
FACILITY NUMBER: 444416796
VISIT DATE: 10/11/2022
NARRATIVE
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Outdoor areas of the home were inspected today and observed to be fenced in. The Applicant states that she is planning to install another fence to section off the grass/dirt area and move all items from the backyard, such a bbq, recycle bins, etc. to behind the fence inaccessible to children. The Applicant additionally states that she is planning to get materials for the backyard from her mother's FCCH for children to play with. The side yard gate will be used as the entrance for parents upon arrival. No outdoor bodies of water were observed during todays inspection. Off limits outside of the home include detached garage and everything beyond fenced area.

LPA observed working smoke detector and carbon monoxide detector and advised Applicant purchase a fire extinguisher for the home. Applicant was provided fire/emergency disaster drill log and was advised it should be completed every 6 months. All cleaning compounds, poisons, medications, and other similar items are stored inaccessible to children. Applicant states that she does not plan to administer medication for children, however would consider it if a child needs it upon registration. LPA advised the Applicant to complete Parent Consent for Administration of Medications and Medication Chart (LIC9221) if a child requires medication while in care and discussed proper storage for medication.

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.

Applicant states that for discipline of the children, she will talk with the child or utilize a "thinking chair" as needed to give the child an opportunity to be away from the situation and calm down. Applicant states that she is planning to have a daily schedule with the children to keep them busy and minimize behavioral issues. LPA advised Applicant that if utilized, recommended duration for "time out" as 1 minute per year of age for the child.
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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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: VARGAS, ARACELI
FACILITY NUMBER: 444416796
VISIT DATE: 10/11/2022
NARRATIVE
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Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen. LPA discussed isolation of sick children with applicant, supervision of children, transporting children, unusual incidents (LIC624B), reporting suspected child abuse, and requirements for additional staff/ adults living in the home.

LPA reviewed and provided documents to Applicant for children's files, personnel files, and facility records (LIC311D). LPA reviewed required documents for posting with the Applicant and she states that she will post them in the day care room. LPA discussed Provider Information Notices (PINs) with applicant and obtained Applicant's email to enroll online. LPA provided Applicant with Child Development Resource Center Resource and Referral information.

102416.5 Staffing Ratio and Capacity was discussed with the Applicant and she understands that the maximum number of children that may be cared for at one time shall be four (4) infants, or six (6) children (no more than three (3) infants), or up to eight (8) children where at least one child is enrolled in or attending kindergarten or elementary school and the second child is at least six years old.

LPA discussed the safe sleep regulations with Applicant and provided 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.

Exit interview conducted and report was reviewed with the Applicant, Araceli Vargas.

LPA advised applicant that a small family day care license will be issued pending manager review and completion of the following corrections:
-Day care materials have been added to the home (toys, shelves, cots, etc.)
-Fire extinguisher has been purchased (at least 2A: 10BC or larger)
-Backyard has been set up for day care children with items moved to be inaccessible to children as needed
-Required postings (emergency disaster plan, parents rights) have been posted
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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