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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004956
Report Date: 10/05/2022
Date Signed: 10/05/2022 10:51:52 AM

Document Has Been Signed on 10/05/2022 10:51 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ARGUETA, NAOMIFACILITY NUMBER:
414004956
ADMINISTRATOR:ARGUETA, NAOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 508-9385
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/05/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Applicant, Naomi ArguetaTIME COMPLETED:
11:05 AM
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On October 5th, 2022 at approximately 8:15am, Licensing Program Analyst (LPA), Leslit Tapia-Mandujano conducted a scheduled Pre-Licensing inspection this day and met with Applicant, Naomi Argueta. Applicant has relocated from Facility # 073409096 to this current location for a Large Family Child Care Home. Fire Request has been sent to Daly City Fire and is still pending. Present in the home today is applicant and assistant caring for 4 children (1 infant and 3 preschool age). LPA and applicant inspected entire home for Health and Safety Hazards.

The applicant lives with the owners of the home, which is a two-level single-family home. Day Care Areas: Downstairs level: which include two rooms, kitchen, and bathroom #1, and the backyard. Off Limit Areas Downstairs level: garage, laundry, and downstairs room. Also the entire second floor: Bedroom #1-#3, bathroom #2 and #3, Living room, Kitchen, and dining room. Hours of operations are Monday to Friday, 7AM to 6PM. All off limit areas are properly barricaded.

LPA observed the following: Day-care is clean, orderly with a variety of age appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and thermometer. The home has no pools or bodies of water in the home. There are no pets in the home. Per applicant, there are no guns or weapons in the home. The home has age appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area will be in daycare area alternating rooms.

The home has sufficient lighting and ventilation. Applicant states they will conduct an emergency drill once every six months and log drills. Applicant's CPR & First Aid will expire 04/2024. Mandated Reporter Training Certificate for applicant will expire on 11/2022.

Applicant was reminded that all adults 18 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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ARGUETA, NAOMI
FACILITY NUMBER: 414004956
VISIT DATE: 10/05/2022
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA received the following documents from applicant, copy of mortgage payment of Owner and letter giving applicant control of property.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior to licensure, applicant must obtain and/or submit the following:
*Fire Clearance received by Daly City Fire Department
*LIC 508: Criminal Record Statement for all adults living in the home
*LIC 9182: Transfer Fingerprint Clearance with copy of ID of all adults living/working in the home
*LIC 999: Floor plans for all levels
*Copy of TB test for all adults

Exit interview conducted and report was reviewed with the applicant, Naomi Argueta.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC809 (FAS) - (06/04)
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