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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700036
Report Date: 07/11/2022
Date Signed: 07/11/2022 12:18:19 PM

Document Has Been Signed on 07/11/2022 12:18 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ARRIETA FAMILY CHILD CAREFACILITY NUMBER:
197700036
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
07/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Martha ArrietaTIME COMPLETED:
12:32 PM
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Licensing Program Analysts (LPA's) Justin Dorsey and Andrew Alemoh met with Licensee, Martha Arrieta and Assistant #1 who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 3 bedroom, 2.5 bathroom home with kitchen, dining room, family room, living room (main care area), laundry room and garage. Upon arrival LPA's observed 3 children with the licensee and assistant #1.

Physical Plant: Main care is provided in the living room. Children use the bathroom near the living room (main care area). Children have access to the living room, children's bathroom and backyard. Off limits areas include the homes entire upstairs, family room, kitchen, dining area, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the kitchen sink), medicines (inaccessible in top kitchen cabinet) and hazardous items (sharp knives inaccessible locked in kitchen drawer) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. LPA's reminded licensee that the fire extinguisher must be serviced or a new extinguisher must be purchased once a year. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in living room. Per Assistant #1 there are no weapon/firearms in the home.

The last fire drill was completed 01/11/22. The last earthquake drill was conducted 07/11/22. LPA's reminded licensee and assistant #1 disaster drills must be completed every six months. Roster complete and maintained current.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARRIETA FAMILY CHILD CARE
FACILITY NUMBER: 197700036
VISIT DATE: 07/11/2022
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Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.

Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner are provided if necessary. LPA reminded assistant #1 If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked under the sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: During the inspection LPA's observed a blow-up pool with water in the back yard. LPA's reminded licensee that all bodies of waters must include a fence. During the visit LPA's observed that the water was removed from the pool. LPA's advised licensee not to have a body of water in the backyard unless it's fenced. The backyard has grass, turf, rubber padding and concrete areas for children to play. LPA's observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 03/2024. Licensees Mandated Reporter was completed 01/23/21. Per assistant #1 they have completed the Mandated Reporter Training but they do not have a copy of the certificate. LPA's advised assistant #1 to get a copy of his mandated reporter training certificate. Children nap on mats in the living room when necessary.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Assistant #1 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 $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA's discussed the safe sleep regulations with licensee 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 licensee Carr 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
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: ARRIETA FAMILY CHILD CARE
FACILITY NUMBER: 197700036
VISIT DATE: 07/11/2022
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A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant #1.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2022 12:18 PM - It Cannot Be Edited


Created By: Justin Dorsey On 07/11/2022 at 11:44 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ARRIETA FAMILY CHILD CARE
FACILITY NUMBER: 197700036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on obersvation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per Assistant #1 water will not be placed back in the pool and the pool will be removed from the backyard by POC due date 07/15/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022


LIC809 (FAS) - (06/04)
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