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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312536
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:09:41 PM

Document Has Been Signed on 08/24/2021 04:09 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BARAJAS, ANGELICAFACILITY NUMBER:
304312536
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Angelica BarajasTIME COMPLETED:
04:35 PM
NARRATIVE
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A Required Annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Hawkins. LPA observed licensee Angelica Barajas caring for 5 napping children; which included (2) infants and (3) preschool age children. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.Currently there is 1 adult including the licensee and no minor children living in the facility. Facility Day care hours are 7am-5:30pm, Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by means of children safety door knobs and latches. The child care area includes the child care front room (living room), kitchen and one additional bedroom, and bathroom which is accessed through the front entrance of the home. The children walk through the hallway to the bathroom. Licensee stated the children's primary area is the living room and the child care room located directly in the back of the home. During todays inspection, LPA Hawkins observed four children (1 infant, 3 preschoolers) at 1:30PM sleeping in a back bedroom located to the right of the home which is identified as an off limit area for day care children and is not approved for children to have access.

Carbon monoxide and smoke detector was observed during inspection, but was not tested due to sleeping children. There is a fire extinguisher in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspection.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BARAJAS, ANGELICA
FACILITY NUMBER: 304312536
VISIT DATE: 08/24/2021
NARRATIVE
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There is no fireplace. The home has age appropriate toys for the ages served.
LPA verified there is a working telephone cellular service in the home. Licensee stated that the right side yard area is used for outside play. There were no poisons or other items observed which could pose a danger to children in care. There are no bodies of water on the premises.
The licensee does have a current roster of children in care.

Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee Pediatric CPR/First Aid certification was valid (expires 12/10/21). Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles, influenza decline letter for licensee were reviewed and are within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. This requirement was met.

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

The licensee understands she must be present in the facility, must ensure children in care are supervised at all times, and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.



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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BARAJAS, ANGELICA
FACILITY NUMBER: 304312536
VISIT DATE: 08/24/2021
NARRATIVE
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CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website
A copy of the California Department of Social Services Lead Information Brochure was explained to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was reviewed with the licensee. The following electronic links were also provided:
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Updated face covering guidance was provided and licensee was to continue to message the “Three W’s”: Wash your hands. Watch your physical distance. Wear a mask. This face covering guidance is for all individuals 2 years and older, except for the exceptions (child’s development, medical exemptions, etc.) that are outlined by CDPH.

Important COVID-19 resources and links were provided:

· CDC Student become sick diagnosis flowchart


· CDC Example of Routine Childcare disinfecting
· CDC Stop the Spread of Germs poster
· COVID-19 General Guidance Cleaning/Disinfecting in Childcare facilities:
· COVID-19 Update Guidance Childcare Programs/Providers link:
https://files.covid19.ca.gov/pdf/guidance-childcare.pdf

· CCLD COVID-19 Licensed childcare and facilities and provider FAQs link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources/faqs-for-licensed-child-care-facilities-and-providers ***continued on page 4***

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BARAJAS, ANGELICA
FACILITY NUMBER: 304312536
VISIT DATE: 08/24/2021
NARRATIVE
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Safe, free, and effective COVID-19 vaccines are now available to everyone age 12 and up. Every Californian can sign up at myturn.ca.gov or call (833) 422-4255 to get their COVID-19 vaccine appointment.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit: Alterations to Existing Buildings or Grounds 102416.3(a)(6) (see LIC 809D).



Due to the Type A violation cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

An exit interview was conducted with licensee in english. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. T
End of Report.

Documents/Information to be updated and returned to the Licensing Office;

- Application for a Family Child Care Home License (LIC 279)


- Facility Sketch (LIC 999)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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Document Has Been Signed on 08/24/2021 04:09 PM - It Cannot Be Edited


Created By: Sherene Hawkins On 08/24/2021 at 03:13 PM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BARAJAS, ANGELICA
FACILITY NUMBER: 304312536

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2021
Section Cited
CCR
102416.3(a)(6)

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102416.3 Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home the licensee shall notify the Department of the proposed changed...(6)Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children
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During todays inspection Licensee removed all children from unlicensed room and made it inaccessible by child safety knob. LPA verified during visit. Licensee will submit an updated facility sketch and request to have additional room added to license at a later date.
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in care. This requirement is not met as evidenced by: 4 children (1 infant, 3 preschoolers) at 1:30PM was observed sleeping in a back bedroom located to the right of the home which is identified as an off limit area. This posses an immediate Health and Safety risk to the children in care.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


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