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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213578
Report Date: 06/02/2021
Date Signed: 06/02/2021 01:02:15 PM

Document Has Been Signed on 06/02/2021 01:02 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ARREDONDO FAMILY CHILD CAREFACILITY NUMBER:
426213578
ADMINISTRATOR:SILVIA ARREDONDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 349-7743
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
06/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Silvia ArredondoTIME COMPLETED:
01:10 PM
NARRATIVE
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On June 2, 2021 @ 9:30 AM, Licensing Program Analysts (LPAs) Martina Jimenez and Francisca Velazquez, conducted a required comprehensive inspection. LPAs asked the Pre- Screening questions related to COVID-19. Licensee's responses to the Pre-screening questions suggest no COVID-19 exposure on site.

LPAs met with Silvia Arredondo, Licensee, and Julissa Diaz, Licensee's daughter. LPAs informed Licensee the reason for the visit. LPAs observed 5 children playing in the home. The main day care areas are the kitchen, living room, dining room, hallway bathroom and day-care room. LPAs observed age appropriate tables, chairs, books toys and games.

LPAs observed in the kitchen and hallway bathroom potato peeler, box of matches, medications, Clorox, hygiene products ( hair spray, nail polish remover, vitamins, lotion, shampoo, toothpaste) and cleaning products, ect.. accessible to children. The outdoor play area is completely fenced, LPAs observed bike area, plastic play structure and shade area.

Licensee stated that there are no guns or ammunition in the home. There are no bodies of water observed in the home. Licensee is not licensed through Foster Care. The carbon monoxide that meets statutory requirements was tested at 10:00 am, and was operational the time of the visit. The smoke alarm was tested at 10:01am, and was operational at the time of the visit. The fire extinguisher was serviced April 4, 2021.

Report Continues on LIC 809 C and LIC D.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578
VISIT DATE: 06/02/2021
NARRATIVE
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Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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 and licensee's daughter, completed the Mandated Reporter Training per AB 1207 on August 7, 2020. Licensee and licensee's daughter are current with immunization requirements per SB 792. Licensee conducted and documented safety drills, last drill was conducted February 18, 2021. Licensee and licensee's daughter are current with CPR and First Aid which expires October 23, 2022. Children's records review revealed child #4, and child #5 file were found to be incomplete (Consent for Medical Treatment, Parents Rights, and Immunization's) at the time of the visit.

Children's roster was found complete and updated. All required State forms were posted at the main entrance of the home.

LPA provided and discussed with the Licensee Safe Sleep Regulation, (PIN 20-24) and Effects of Lead Exposure per AB 2370. LPA was provided a brochure on Mandated Reporter Training.

The visit and the report was translated in Spanish by LPA Jimenez.

Today, deficiency cited under Title 22 Division 12 Appeal rights given.
Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/02/2021 01:02 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/02/2021 at 11:22 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2021
Section Cited
CCR
102417(g)(4)

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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Licensee stated that she will submit photos and a written plan on or before 6/3/21 regarding how Licensee shall make toxins, poisons and sharp items immediate danger inaccessible to children in care at all times. Plan and photos of corrections to be submitted via email.

Martina.Jimenez@dss.ca.gov
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This requirement was not met as evidenced by the following: Based on the LPA's observation in the kitchen and hallway bathroom the following: potato peeler, box of matches, medications, Clorox, hygiene products ( hair spray, nail polish remover, vitamins, lotion, shampoo, toothpaste) and cleaning products, ect.. accessible to children. This poses an immediate health and safety risk to 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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2021


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/02/2021 01:02 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/02/2021 at 11:56 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ARREDONDO FAMILY CHILD CARE
FACILITY NUMBER: 426213578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2021
Section Cited
CCR
102417(g)(7)

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement was not met as evidenced by the following: Based on the LPA's observation/record review revealed Consent for Medical Treatment not to be in C4 file. This poses a potential risk to the health, & safety to children in care.
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Licensee acknowledged not having Consent for Emergency Medical Treatment form in C5 file.

Licensee will provide form to be completed by parent on or before 06/11/21.
Type B
06/11/2021
Section Cited
CCR
102419(d)

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At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights. This requirement was not met as evidenced by the following: Based on the LPA's observation/record review revealed parents right not to be in C5 file. This poses a potential risk to the health, & safety to children in care.
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Licensee acknowledged Parents Rights form not in C5 file.

Licensee will provide form to be completed by parent on or before 06/11/2021.
Type B
06/11/2021
Section Cited
CCR102418(a)

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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement was not met as evidenced by the following: Based on the LPA's observation/record review revealed record of immunization's not to be in C4 file.
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Licensee acknowledged Record Immunization's form not in C4 file.

Licensee will provide form to be completed by parent on or before 06/11/21.
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This requirement was not met as evidenced by the following: Based on the LPA's observation/record review revealed record of immunizations not to be in C4 file. This poses a potential risk to the health, safety or personal rights of persons 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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2021


LIC809 (FAS) - (06/04)
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