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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700335
Report Date: 03/18/2022
Date Signed: 03/18/2022 12:51:21 PM

Document Has Been Signed on 03/18/2022 12:51 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ARMENTA, MONICAFACILITY NUMBER:
015700335
ADMINISTRATOR:ARMENTA, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(732) 997-8190
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
01:00 PM
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On 03/18/2022, Licensing Program Analyst (LPA) Jaylena Miller conducted a Prelicensing Inspection. LPA met with licensee Monica Armenta for an announced change of location Inspection. Present for the inspection was the licensees fingerprint cleared and associated adult son. The licensee plans to operate Monday-Friday from 7:00am-5:30pm for children ages 0-5 years old. LPA conducted a health and safety inspection inside and outside with licensee.

The home is a single story home with 4 bedrooms including a master bedroom with master bathroom, 2 additional bathrooms, a living room, dining room, family room, laundry room, kitchen, garage and back yard which is completely fenced in. As you enter the front door the living room is to the right and the dining room is to the left and will be used as the secondary day care area. There is a hallway adjacent to the living room where all 4 bedrooms and 1 bathroom is located. Across from the hallway is the kitchen. Adjacent to the kitchen is the living room which is the main day care area. There is a small doorway to the left of the living room where the laundry room, garage and second bathroom are located as well as a sliding glass door to the right that leads to the backyard. The home is neat and clean with central heating and ventilation for safety and comfort.

The OFF-LIMITS areas are the hallway with all the bedrooms, 1 bathroom and garage and will be made inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMITS areas are the living room, dining room, kitchen, family room, and laundry room. The outdoor play area will be the backyard which is completely fenced in as well and safety gates put in place around the yard to prevent access to children in unwanted areas. The isolation area will be the living room next to the front door.

There are no pools, hot tubes or any other bodies of water present at the facility during today’s inspection. All hazardous materials and toxins are kept out of reach from children and would not be accessible to children during daycare hours. The home has a fully charged 2A-10-BC fire extinguisher, working smoke detector, working carbon monoxide, telephone, and first aid kit. Per licensee, there are no firearms on the premises. The kitchen cabinets and drawers have child safety latches and LPA did not observe any knives out during the inspection.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ARMENTA, MONICA
FACILITY NUMBER: 015700335
VISIT DATE: 03/18/2022
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The Licensee has received certificates of completion in Health and Safety on 09/28/2019, the mandated reporter training on 3/18/2022 and CPR/First Aid is current and expires on 06/21/2023. Licensee is scheduled for the lead poison prevention training on 03/26/2022. LPA Miller discussed with licensee the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved.

LPA reminded licensee a roster of the children must be properly maintained, and the fire/disaster drills every six months must be documented.

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

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.

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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/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.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ARMENTA, MONICA
FACILITY NUMBER: 015700335
VISIT DATE: 03/18/2022
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Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

LPA Miller is granting a provisional large family child care home license as of 03/18/2022 pending an approved fire clearance however, the facility must operate as a small family child care home until the fire clearance is granted. This provisional license is valid for 45 days.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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