<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408986
Report Date: 10/14/2021
Date Signed: 10/14/2021 04:15:30 PM

Document Has Been Signed on 10/14/2021 04:15 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:BAROJAS-AMEZCUA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 595-2969
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:BAROJAS-AMEZCUA, MARIATIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 On 10/14/2021 Licensing Program Analyst (LPA) L. Chew arrived at the home for an unannounced 1 year required inspection to ensure the health & safety standards as required by Title 22 regulations governing family childcare homes were met. LPA met with Licensee BAROJAS-AMEZCUA, MARIA. LPA advised Licensee purpose of today’s inspection. Licensee guided LPA on tour of facility utilized for childcare inside and out. Present during today inspection were 6 preschool-age and 3 infant children in care and fingerprint/associated licensee mother, Anna Amezcua. During today’s inspection LPA observed Licensee to be operating within the licensed capacity. Licensee states facility operation hours is 7:45 AM to 5:30 PM Monday – Friday. The home is a single-story 4-bedroom 1-bathroom which includes living room, dining room, family room, kitchen, and fully fenced backyard. The backyard has an outdoor fenced enclosure for play with a detached shelter area which was converted into an out-house that is used for childcare which has 1 bathroom for children in care. Licensee states the classroom is utilized for childcare. Mandatory forms were posted near entryway of outhouse (classroom) area. Licensee has a current roster of the children in care available for review and copy obtained during today's inspection. On-limit areas Outdoor fenced enclosure (that is used for outdoor play) and detached out-house (classroom) area. Licensee states children in care will eat inside the main home within dinning/living room area.Off-limit area Main home consist of kitchen, private 4-bedroom, main bathroom family room and paved back yard section. 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. Isolation Area: Detached out-house (Classroom) area.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BAROJAS-AMEZCUA, MARIA
FACILITY NUMBER: 073408986
VISIT DATE: 10/14/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was reminded off limit areas shall be made inaccessible by closed and/or locked doors, child proof gates and/or visual supervision. At 11:04 AM LPA reviewed children files, staff file and facility file. Licensee is following new immunization law which pertains to day-care providers. Mandated Reporter Training was completed on 12/3/2020, expiring on 12/3/2022. EMSA Training includes Nutrition - Pediatric Preventative Health and Safety was completed on 8/17/2019. Lead Poisoning Prevention for childcare providers was completed on 6/7/2021. Family Childcare Orientation was completed on 11/21/2017. Pediatric CPR and First Aid certificates was completed on 10/26/2019, expiring on 10/26/2021. Control of property was proven 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 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. Licensee states there are no firearms present on the premises.

During today’s inspection LPA did not observe any bodies of water on the premises. Licensee states she has 3 pets (3 small dogs). Licensee displayed a up-to-date fire safety drill, last drill was conducted on 10/12/2021. LPA reminded Licensee, 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. 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), 3 children (ages 14, 11 and 4 years old) reside in the home. 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. Licensee was encouraged to stay up to date with department quarterly updates by visiting ChildCareAdvocatesProgram@dss.ca.gov..

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 2 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BAROJAS-AMEZCUA, MARIA
FACILITY NUMBER: 073408986
VISIT DATE: 10/14/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee states no Incidental Medical Services (IMS) is being provided at facility. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102n417. 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. LPA discussed the safe sleep regulations with the licensee. LPA discussed the Child Care Licensing Safe Sleep webpage 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee BAROJAS-AMEZCUA, MARIA.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3