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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700066
Report Date: 06/27/2022
Date Signed: 06/30/2022 06:55:57 AM

Document Has Been Signed on 06/30/2022 06:55 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ARELLANO FAMILY CHILD CAREFACILITY NUMBER:
157700066
ADMINISTRATOR:ROSA ARELLANOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 889-0681
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Rosa ArellanoTIME COMPLETED:
03:51 PM
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 On 02/27/2022, at 1:14 p.m. Licensing Program Analysts (LPA) Esequiel Rodriguez made an announced inspection with Applicant, Rosa Arellano for the purpose of conducting a required facility Pre-Licensing Inspection prior to license for a prospective Large Family Child Care Home, and to ensure the Family Child Care Home (FCCH) facility meets basic licensing requirements set forth by Title 22 California Code of Regulations, Health and Safety and Statutory requirements. And to ensure the facility is set up to provide a safe and healthy place for children. The LPA met with Applicant and stated the purpose for the inspection as stated above. The LPA explained that Community Care Licensing Division (CCLD) is focusing efforts on, but not limited to, three priority areas: prevention, compliance, and enforcement. Additionally, the LPA explained that CCL will offer resources and continue to assist Ms. Arellano in her ability to consistently demonstrate compliance.

The LPA provided and discussed the Prelicensing Entrance Check List form (LIC 9280) to the Licensee. The tentative hours of operation will be Monday through Friday from 6:30 a.m to 6:00 p.m. However, the schedule may vary depending on the needs/work schedule of the parents. At 1:50 p.m. the LPA along with the Applicant toured the facility inside and out and inspected the following:

The physical plant of the prospective FCCH is a one story house. It consists of a living room, kitchen, dining area, laundry room, two bathrooms, four rooms and a garage. It has a back and front yard including a side runaway yard. The main areas designated to provide childcare are the living room, dinning room and backyard area. Off limit areas are the family rooms, garage, laundry room, doghouse area and any other area that may create a hazard. The kitchen, in addition with having all cabinets drawers inaccessible to children, it is gated.

The home is neat and clean with heating and ventilation for safety and comfort. Carbon Monoxide Detector, Smoke Alarm(s) and Fire Extinguishers meet standards established by the State Fire Marshall.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Esequiel Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARELLANO FAMILY CHILD CARE
FACILITY NUMBER: 157700066
VISIT DATE: 06/27/2022
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Off Limits areas have been properly designated. There are no Bodies of Water. Fireplace and/or heaters are properly protected/screened to prevent access by children, There is a working Telephone, the facility does not have a land line phone. However, per applicant there will always be a cellular or smart phone available and 100% charged at the facility. There are no stairs. Outdoor play area contains age appropriate toys and is free of hazards. The home has safe toys, play equipment and materials. Toilet and faucets are clean, safe and operable; bathtub and shower are free of hazard. All electrical outlets are inaccessible to children. The home has appropriate materials for napping (cots, mats, cribs and/or playpens) are available. All windows are free of cracks, bugs and debris. Hanging window blinds cords are inaccessible to children. The garage is off limits, nonetheless, per applicant, solvents, gasoline, oil, turpentine, paint, sharp tools, lawn mower, gardening tools, poisonous plants, abandoned machinery, old refrigerators/freezers, old vehicles, etc., will always be inaccessible to children. Emergency supplies are maintained in a container located in the backyard. At the time of the inspection, the home was free from defects or conditions which might endanger a child.

The facility has a first-aid kit with all required supplies (Current edition of a first-aid manual, Sterile first-aid dressings, Bandages or roller bandages, Adhesive tape, Scissors, Tweezers, Thermometer, and Antiseptic solution.) The kit is accessible to provider(s) but inaccessible to children. The Emergency Disaster Plan and Earthquake Preparedness Checklist is posted in a prominent place and will ensure fire drills and disaster drills are conducted at least once every six months.

The applicant is well aware that cribs or play pens/yards being used or planned to be used have not been banned or recalled by the United States Consumer Product Safety Commission and that the she will be present in the home and ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee will arrange for a substitute adult to care for and supervise the children during his/her absence. She knows that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Applicant is aware that when a child shows signs of illness the child is separated from other children and the nature of the illness determined. If it is a communicable disease the child will be separated from other children until the infectious stage is over. The designated area is located in the living room.
SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Esequiel Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARELLANO FAMILY CHILD CARE
FACILITY NUMBER: 157700066
VISIT DATE: 06/27/2022
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The applicant as well as her assistant have a current criminal background and association. LPA explained that all adults 18 years old 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.

The applicant has documentation of proof of control of property at the FCCH and is available for review. The applicant/License will ensures fire drills and disaster drills are conducted at least once every six months.

The applicant has completed the required mandated reporter training and is aware that everyone providing services to children must complete this training. The mandated reporter training renewal status is every two years following the date on which they completed the initial mandated reporter training. The applicant also has a current pediatric first aid and CPR. Posted on a prominent place are the Emergency Disaster Plan (LIC 610A); the Earthquake Preparedness Checklist (LIC 9148), Notification of Parents' Rights Poster (PUB 394.) and when licensed, the Facility License, (LIC 203) will also be posted in an area of the home where it can be easily seen. The licensee is aware of reporting requirements in accordance with (IAW) Title 22 requirements.



The applicant has two pet dogs and birds. The dogs have received all required vaccines. LPA Rodriguez explained that when there are animals in the home, there are precautions the Licensee must be aware of, and to notified parents prior to admission that there is/or are pets/types in the home. Additionally, there are many things to consider when mixing children with animals. Also, to be aware of children potential allergies to certain animals as well as foods, and to be knowledgeable about emergency procedures that need to be taken in case a pet bites or scratches a child and or if the child has an allergic reaction.

Following the inspection, to increase provider knowledge and competency of child development and licensing requirements, LPA Rodriguez provided additional information and resources. See LIC 9102 Technical Assistance forms, dated 06/27, 28 & 29/2022) for information covered. At the time of the is inspection, the facility was in compliance per Title 22 regulations, and ready for licensure.



SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Esequiel Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARELLANO FAMILY CHILD CARE
FACILITY NUMBER: 157700066
VISIT DATE: 06/27/2022
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The LPA discussed any observations and pertinent regulatory licensing standards and responded to applicant's concerns and viewpoints. Also provided follow up information and technical assistance via advisory notes regarding where to locate (PINS) Provider Information Notices. Where to locate training. How to access CCL Web applications/links, and how to subscribe to Child Care Licensing Quarterly Updates and other pertinent information.

At the time of the inspection there were no pending issues or concerns that precludes applicant from licensure. Therefore, the home is ready for licensure.

Copy of this report and LIC9102 Technical Assistance advisories were provided to Ms. Arellano and an exit Interview was conducted.
SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Esequiel Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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