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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409096
Report Date: 12/08/2021
Date Signed: 12/09/2021 09:13:57 AM

Document Has Been Signed on 12/09/2021 09:13 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ARGUETA, NAOMI & JENNIFERFACILITY NUMBER:
073409096
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
12/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Naomi and Jennifer ArguetaTIME COMPLETED:
12:50 PM
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On 12/08/2021 at 9:15am Licensing program Analyst (LPA) Diana Campos arrived at the facility for an unannounced required inspection. LPA met with the licensees Naomi Argueta and Jennifer Argueta. Present during the inspection were licensees husband and 5 children in care.
LPA toured the areas of the home that are used for children in care, with the licensee, to conduct a health and safety inspection.

The home is a single story home which is neat and clean with heating and ventilation for safety and comfort. The home consists of the living room, kitchen/dining room, converted garage, 3 bedrooms and 2 bathrooms.
The OFF LIMIT areas: bathroom in the master bedroom which will be made inaccessible by closed and/or locked doors and visual supervision.
The ON LIMIT areas include the living room, kitchen/dining room, all three bedrooms, the hallway bathroom, converted garage which is used as an additional play/classroom space, and the back yard patio. Licensee was reminded that children cannot eat or sleep in the converted garage.
The ISOLATION AREA will be the bedroom to the left of hallway away from other children in care. The outdoor play area is the fenced backyard, which is free from defects or dangerous conditions. There is an ample supply of age appropriate furniture, equipment, toys and activities that are safe and appear to be in good repair. LPA did not observe any hazardous items, toxins or medications accessible to children today. Per licensee there are no firearms in the home.

The home has a fully charged 2A10BC fire extinguisher, combination smoke/carbon monoxide detector, telephone, and first aid supplies. The licensee's CPR/First Aid certificates are current and expire on 06/13/22. The licensee completed the required mandated reporter training in 11/11/2020. The last fire/disaster drill is documented as being conducted on 09/01/21. LPA viewed the postings, including those related to COVID-19, and verified that all required postings are visible. LPA reviewed children's files and facility files.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ARGUETA, NAOMI & JENNIFER
FACILITY NUMBER: 073409096
VISIT DATE: 12/08/2021
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No IMS Service provided at this time. 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 (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: http://www.ada.gov/childqanda.htm

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 maximum per day/per person will be assessed if this regulation is violated.

LPM discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licening/public-information-and-resources/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.

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/inspection-process.

There are no deficiencies being cited today. This report will remain on file for 3 years. A Notice of Site Inspection was provided and the licensee was reminded that it must remain posted for 30 days. An exit interview was conducted with licensees.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC809 (FAS) - (06/04)
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