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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020725
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:52:56 PM

Document Has Been Signed on 10/06/2021 01:52 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BARRAGAN FAMILY CHILD CAREFACILITY NUMBER:
198020725
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Applicant, Jacqueline BarraganTIME COMPLETED:
02:00 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 10/06/2021 at 10:30 a.m., Licensing Program Analysts (LPAs) Jose Guzman and Lilli Babcock conducted an announced Pre-Licensing inspection to inspect the facility for initial license. Risk assessment was conducted prior to entry. Upon arrival LPAs met with Applicant, Jacqueline Barragan. Applicant’s mother, grandmother, three uncles, aunt, cousin, son, and nephews were also present. Applicant is requesting a small family child care license. The facility is a one story 3 bedroom, 3 bathroom home. Also, on the property is a 2 bedroom 1 bathroom guest home where 2 adults and 2 minors reside. Individuals residing on the property are 7 adults and 3 minors.
Applicant guided LPAs on a tour of the facility both indoors and outdoors. There is a separate area in the home which has been divided to provide an additional living space where the Applicant’s grandmother resides. In addition, the storage area has also been converted into a living space where the Applicant’s unfingerprinted uncle is residing. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPAs observed a wall fireplace located in the living room that is covered with an unbolted wire mesh gate behind open cubbies, making the fireplace accessible. Per Applicant, child care will be provided from 7:00am to 6:00pm, Monday through Friday. Applicant understands that care for a child should not exceed 24 hours.
Per Applicants, the following areas will be used for day-care: Living room, 1 bedroom (to gain access backyard), 1 bathroom, and backyard
Per Applicants, Off-limits areas include: Side yard, 1 bedroom, 1 bathroom, kitchen, dining room, 2 storage rooms, Grandmother’s attached unit, and guest house. The doors to the off-limit areas will remain closed during operating hours. All children will not have access to guest house.
Page 1 of 5
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BARRAGAN FAMILY CHILD CARE
FACILITY NUMBER: 198020725
VISIT DATE: 10/06/2021
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
The Applicant does have all appropriate forms posted. LPA confirmed with the Applicant that most adults residing/working in the home have obtained criminal record and TB clearances. The facility has a working phone. Applicant has taken the 8-hour First Aid/CPR training, her certificate is valid thru 10/2022. Proof of immunization against influenza, pertussis, and measles for the Applicant was readily available during today's inspection. Applicant has completed the Mandated Reporter Training.
There is an operational combination smoke and carbon monoxide detector maintained in the home. The valve on the required 2A 10BC fire extinguisher indicates fully charged purchased 11/09/2020. The home has electrical outlet covers throughout and maintains a First Aid and Emergency Kit. There are some age appropriate materials and sleeping equipment was available for children to be enrolled in care. Per Applicant, there are no firearms in the home. The outdoor play area is a fenced backyard. Applicant must remove poisons from the outdoor laundry room and must be locked with a key or combination lock. LPAs did not observe any bodies of water on the premises.

The following was discussed with the applicant:


· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
Page 2 of 5
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BARRAGAN FAMILY CHILD CARE
FACILITY NUMBER: 198020725
VISIT DATE: 10/06/2021
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
· A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.


· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

LPA advised the Applicants how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. The LIC 311D Forms/Records to Keep in Your Family Child Care Home and hard copy of A Child Care Provider’s Guide to Safe Sleep was provided.
Page 3 of 5
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BARRAGAN FAMILY CHILD CARE
FACILITY NUMBER: 198020725
VISIT DATE: 10/06/2021
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
Applicant states that she will care for infants. Applicant states that infants will sleep in the living room where they are constantly be supervised. LPA informed applicant that one crib for each infant in care will be needed. LPA informed Applicant that cribs or play yards shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA informed Applicant that infants cannot be swaddled while in care. LPA advised the Applicant that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Applicant. LPA provided the Applicant with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
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
Based on the LPA observation, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 10/27/2021:
· Provide proof of bolted fireplace making fireplace inaccessible.
· Provide proof of removal of poisons and are locked with a key or combination lock.
· Provide an updated indoor/outdoor facility sketch to include the guest home.
· Provide an updated application to include all adults living in the home.
· Provide proof of completed outdoor patio.
· Provide proof of fingerprints for all adults living in the home.
· Provide proof of cleared storage area.
Page 4 of 5
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BARRAGAN FAMILY CHILD CARE
FACILITY NUMBER: 198020725
VISIT DATE: 10/06/2021
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
A small family child care licensee may be granted after final review of the application and upon receipt of proof of corrections for the above. Once licensed, the Applicant is required to adhere to the terms and limitation as stated on the license. Exit interview was conducted with Applicant, Jacqueline Barragan.

Page 5 of 5

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5