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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100999
Report Date: 07/19/2023
Date Signed: 07/20/2023 08:22:20 AM

Document Has Been Signed on 07/20/2023 08:22 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ARABO, BALSAM FAMILY CHILD CAREFACILITY NUMBER:
376100999
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee, Balsam Arabo TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Balsam Arabo and granted entry after identifying herself and disclosing the purpose of her visit. Licensee's husband, Raymon Arabo provided translating services as the licensee's primary language is Caldean. The licensee is using the following areas for daycare: Living room, kitchen, downstairs bathroom. Off limit areas include: All upstairs and backyard. The facility currently has 5 children in care of which 0 were infants.

At 3:14pm LPA/licensee tested the carbon monoxide detector, smoke detector and fire extinguisher located in the kitchen/hallway area. All devices were functional. There are no pools/bodies of water on the premises. There are no weapons or ammunition stored in the home. There are no open face heaters/fireplaces. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. There is no outdoor play available at this time. The last disaster/fire drill was conducted on 06/13/2023. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.

Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights.

Pediatric CPR and First Aid cards are current and will expire on 10/2024. Mandated reporter training was waived due to licensee's primary language. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ARABO, BALSAM FAMILY CHILD CARE
FACILITY NUMBER: 376100999
VISIT DATE: 07/19/2023
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Safe Sleep
LPA discussed the safe sleep regulations with Licensee, Arabo 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, Arabo 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.

Criminal Record Clearance
Licensee, Arabo was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in health and Safety code section 1596.871, must obtain 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

No IMS
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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.

MyChildCarePlan.org
Licensee, Arabo was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ARABO, BALSAM FAMILY CHILD CARE
FACILITY NUMBER: 376100999
VISIT DATE: 07/19/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s visit, no deficiencies were observed at this time. Exit interview conducted and report was reviewed with Licensee, Arabo.

During the exit interview, the Licensee, Arabo confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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