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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408986
Report Date: 07/01/2021
Date Signed: 07/01/2021 12:20:49 PM

Document Has Been Signed on 07/01/2021 12:20 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BAROJAS-AMEZCUA, MARIAFACILITY NUMBER:
073408986
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:BAROJAS-AMEZCUA, MARIATIME COMPLETED:
12:40 PM
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On July 01, 2021 at 08:00 AM Licensing Program Analyst (LPA) L. Chew and Licensing Program Manager (LPM) L. Dyson arrived at the home for an unannounced Licensee initiated Case Management inspection. Licensee requested on application to increase capacity from a small family childcare home to a large. During inspection LPA and LPM confirmed the health & safety standards as required by regulations governing family childcare homes were met. LPA and LPM met with Licensee BAROJAS-AMEZCUA, MARIA.
Licensee guided LPA and LPM on a tour of areas utilized for childcare.

This is a single-story 4-bedroom 1 bathroom home which includes living room, dining room, family room, kitchen, and fully fenced backyard. Present during today inspection were Licensee, licensee 2 school-age children (11 and 14 y/o) and 6 children in care (2 infants, 3 preschooler and 1 school-age). During inspection LPA and LPM observed Licensee to be operating within the licensed capacity. Licensee was reminded, if no assistant is present at a Large Family Child Care Home, then Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee was reminded an assistant must be at least 14 years of age and any assistant under the age of 18 years old cannot be left alone with children in care. Licensee state 2 adults (Licensee & fingerprint cleared and associated husband), 2 school-age and 1 preschooler (ages 14, 11 and 4 years old) reside in the home. Mandatory forms were posted. Licensee has a current roster of the children in care available for review and copy obtained during today's inspection.
On-limit areas consist of an outdoor fenced enclosure that is used for outdoor play and a detached outbuilding (classroom) area that has a bathroom for children in care. Licensee states children in care will nap and eat inside the main home within dinning and family room area.
Off-limit area consists of: Main home area kitchen, 4-bedroom, 1 bathroom living room. Paved back yard area including portable basketball court, carport/garage area, locked storage area, garden area bar-b-que grill area, centered grass/lawn area.
Licensee was reminded off limit areas shall be made inaccessible by closed and/or locked doors, gates and visual supervision. LPA and LPM observed outdoor off-limit area is not free of hazards.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2021
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: BAROJAS-AMEZCUA, MARIA
FACILITY NUMBER: 073408986
VISIT DATE: 07/01/2021
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Licensee is following new immunization law which pertains to day-care providers. Pediatric CPR and First Aid certificates was reviewed and expires on 10/26/2021. Mandated Reporter Training completed on 12/3/2021. Licensee Preventative Health and Safety Certificate was completed on 8/17/2019 including 1 hour nutrition. Lead Poisoning Prevention for childcare providers was completed on 6/7/2021. Family Childcare Home Orientation was completed on 11/21/2017.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children in care. LPA reminded licensee that all adults residing in the home must have criminal record/TB clearances.

LPA and LPM verified control of property by Grant of Deed, The home is equipped with a fully charged 3A40BC fire extinguisher. The home has a working smoke detector, carbon monoxide detector, and telephone. LPA and LPM observed a fully stocked First Aid Kit. Detergents, cleaning compounds, medications and other items which could pose a danger were inaccessible to children in care. Fire Clearance inspection was conducted and approved for capacity increase.

Licensee states there are no firearms present on the premises LPA observed during inspection the home has no bodies of water. There were 3 dogs present at the home. Licensee displayed a up-to-date fire safety drill, last drill was conducted on 4/9/2021. Children’s records were not reviewed during today's inspection.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. Licensee was reminded to comply with New Safe Sleep Regulation.

No deficiencies cited today. Licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov for Quarterly Updates.

Exit interview conducted. Licensee was provided a copy of appeal rights. Notice of site visit was provided and must remain posted for 30 days. No deficiencies being cited.
A copy of this report shall be maintained for 3 years and available for public review upon request. Licensee is approved for capacity increase effective today, July 1, 2021.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
LIC809 (FAS) - (06/04)
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