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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409184
Report Date: 01/27/2022
Date Signed: 01/27/2022 12:05:24 PM

Document Has Been Signed on 01/27/2022 12:05 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:INIGUEZ, JANELLE & DANIELFACILITY NUMBER:
073409184
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janelle IniguezTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Cherie Acosta met with Janelle Iniguez for an announced Prelicensing Inspection. Present during the inspection was the applicant and her minor child. Daniel Iniguez was not present during the inspection. Applicant states that the hours of operation will be 6:00am to 6:00pm Monday through Friday. Applicant submitted COVID -19 Self-Assessment Guide. LPA reviewed responses with applicant and provided technical assistance.

The home was toured for a Health and Safety Inspection. This is a single story home . The home consists of a living room, kitchen, dining room, nook, laundry room, four bedrooms, two bathrooms, an attached garage and a detached garage/workshop. Bedroom listed on facility sketch as bedroom #4 is an office. The on limit area that will be used for child care are the living room, dining room, nook, and bathroom located near bedroom #3. The remainder of the home will be off limits to children. Off limits areas will be made inaccessible by use closed and/or locked doors and visual supervision. The attached garage is currently being converted to a living space. Applicant has a permit in progress with the City of Brentwood. The construction area is fenced off and made inaccessible to children. Construction will be done after child care hours as stated by the applicant. The nook will be used as the isolation area. The fenced backyard will be used for outdoor play. The home is neat and clean with heating and ventilation for safety and comfort. There are age appropriate toys in the home. There are no pools, hot tubs or any other similar bodies of water at this home. There are no firearms in the home as stated by the applicant. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 2A10BC fire extinguisher.

The applicant has current CPR/First Aid which expires 2/23. Applicant completed mandated reporter training 2/11/21. Applicant is in compliance with required immunizations. LPA verified applicant has control of the property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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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: INIGUEZ, JANELLE & DANIEL
FACILITY NUMBER: 073409184
VISIT DATE: 01/27/2022
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Prior to licensure applicant shall do the following:

Applicant shall add child proof latches on the drawer where sharp objects are kept and on the cabinet located under the kitchen sink.

Exit interview conducted and report was reviewed with Janelle Iniguez
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
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