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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700398
Report Date: 11/01/2022
Date Signed: 11/01/2022 02:37:12 PM

Document Has Been Signed on 11/01/2022 02:37 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:ARIAS, SALWA & ANGELFACILITY NUMBER:
015700398
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Salwa AriasTIME COMPLETED:
03:06 PM
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On Nov 1, 2022, Licensing Program Analyst (LPA) Sidney Cortez conducted an inspection with applicant Angel and Salwa Arias . The purpose of this inspection was to conduct an Announced Pre Licensing Inspection. Applicants plan to operate the facility Monday through Friday from 6:00 am until 9:00pm. The home was toured to conduct a Health and Safety Inspection. The home is 2 stories (2 levels). The home consists of a 4 bedroom, 2.5 bathroom, living room, family room, dining room, kitchen, backyard and garage. The OFF LIMIT AREAS are the dining room, kitchen, 3 bedrooms upstairs, and 2 bathrooms upstairs, and garage. The ON LIMIT AREAS are the living room, family room, 1 bedroom upstairs (for napping), 1 bathroom downstairs, and backyard . The ISOLATION AREA is the upstairs bedroom (napping) area.
There are toys and learning materials in the activity room area. Hazardous materials and toxins are kept out of the reach of children.

There is no pool or any type of bodies of water in the home. Per applicant, there is a fire-arm in the house but is locked in a safe, and the ammunition are in a separate safe. The home is neat and clean with heating and ventilation for safety and comfort.
The home has one fully charged fire extinguisher (model 2A10BC), and working smoke/carbon monoxide detectors, first aid kit, emergency supplies, and working telephone. The applicant’s Health and Safety training is completed, and licensee’s CPR and First Aid certificates are current and both certificates will expire on Sept 2023. Licensee has also has a certificate for the Lead Poisoning Training completed in Aug 2022.

The applicant is in compliance with new immunization law. Applicant received a certificate in mandated reporter training in November 2021 which is valid for 2 years.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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