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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416796
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:10:58 AM

Document Has Been Signed on 10/20/2022 11:10 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:
10/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Araceli VargasTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Applicant, Araceli Vargas, to conduct follow-up pre-licensing inspection for home compliance with Title 22 California Code of Regulations. Upon arrival, LPA was admitted into the home by Applicants adult daughter, Cynthia Loera, and the Applicant arrived shortly after.

During todays inspection, LPA observed the home with toys and equipment for children that are age-appropriate and safe for children's use. The home has twelve (12) cots and two (2) pack n plays available for napping. The Applicant has modified her on-limits areas to include the living room and kitchen. The living room will now be used for napping space and the kitchen has a table and chairs for children to eat at. Off-limits in the home include: two (2) bedrooms and one (1) bathroom. There is a fish tank located in the dining room and another located in the living room that are at least five (5) feet high and the body of water is inaccessible to children. LPA advised screen covers for the top of the fish tank, however the tanks are high enough off the ground that children cannot access or reach the top of the tanks. The home has a diaper changing table available for children who may need it. There is a fire place located in the living room that is locked, screened, and inaccessible to children. LPA advised the Applicant that the fireplace must not be used during day care hours and should remain cool to the touch while children are present. Knives in the kitchen have been moved to the upper cabinet to be inaccessible to children and the Applicant states that she will be purchasing a new garbage can as well.

Outdoor areas of the home were inspected and LPA observed that a newly constructed fence and railings are installed in the backyard. The area for children's use is fenced in, with grass and concrete areas for playing. There are sufficient toys and equipment available outside for children's use. The Applicant states that she will move the remaining items in the backyard, such as garbage bins and BBQ, behind the fence to be inaccessible to children. LPA requested the Applicant submit photos of the items when she has moved them to beyond the fenced area for children. Off-limits outside of the home include: detached garage and everything beyond fenced area. No outdoor bodies of water were observed during todays inspection.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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: VARGAS, ARACELI
FACILITY NUMBER: 444416796
VISIT DATE: 10/20/2022
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LPA observed all required postings on a bulletin board near the entrance of the home. The Applicant has a 3A40BC fire extinguisher (last serviced: 2/2022) present in the home and states that she is planning to mount it to the wall in the kitchen. LPA advised that fire extinguishers continue to be serviced annually.

LPA provided Notification of Children's Personal Rights (PUB394L) and advised the Applicant that she will scan a copy of the Emergency Disaster Plan (LIC610A) to her. LPA requested that the facility sketch (LIC999) is updated to reflect changes to the on-limits areas of the home.

LPA additionally advised the Applicant to transfer her daughters fingerprint clearances to her license prior to starting care of children and that her granddaughter would be considered part of the ratio when she is present in the home.

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:

-Updated Facility Sketch (LIC999) to reflect on-limit/off-limit changes (LPA will confirm if adjustments are needed based off of sketch at the SJ office)
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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