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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411683
Report Date: 11/15/2021
Date Signed: 11/15/2021 04:25:09 PM

Document Has Been Signed on 11/15/2021 04:25 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BARRENECHEA, JOHANAFACILITY NUMBER:
434411683
ADMINISTRATOR:BARRENECHEA, JOHANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4088064794
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Johana BarrenecheaTIME COMPLETED:
04:30 PM
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On 11/15/2021 at 12pm Licensing Program Analyst (LPA) Sabina Dodoo, met with Licensee Johana Barrenechea for an UNANNOUCED ANNUAL REQUIRED INSPECTION. Present for the inspection were 2 adults (licensee and an aide) the licensee was fingerprint cleared but the aide was not, and 5 children were present in one classroom. The classroom is within ratio. LPA provided licensee a copy of form LIC 125. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am to 5:30pm. The capacity of the Family Child Care Home is 14 children.

The Family Child Care Home is a single-story home with an attached garage and backyard. The garage has been converted into a classroom. There are chairs and tables for children. Sleeping mats are also available with each child’s linen to sleep on. There is a changing table since all children are in diapers. The changing table is within arms reach to a sink. The sink has pumping soap and hand towels hanging with the children’s name next to each towel. LPA (Sabina) observed the classroom to be neat with proper ventilation and materials equipped to care for the children. Licensee(Barrenecha) allows the parents to enter through the back gate of the house which allows easy entry to the garage (classroom area). The children do not have access to the main house. There is a room that is next to the kitchen that has been converted into an infant sleeping room. There are two see through cribs with proper fitting mattresses. The cribs are free of object inside and around the side of the cribs. There is enough space to walk in between the cribs. A sleep log is also kept by the licensee. The children get their temperatures checked and they wash their hands upon entry. All linens are washed by licensee every Friday. LPA(Sabina) observed the bulletin board (parent’s rights, emergency disaster, earthquake drill, schedule, personal rights and facility license.)
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/15/2021 04:25 PM - It Cannot Be Edited


Created By: Sabina Dodoo On 11/15/2021 at 02:19 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BARRENECHEA, JOHANA
FACILITY NUMBER: 434411683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in count one out of one which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2021
Plan of Correction
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Licensee will have aide complete fingerprint clearance within 24 hours. Licensee understands Shamantha Moreno shall not be permitted to return to the Family Home Care until the fingerprint has been cleared. For the future Licensee will ensure a clearance has been granted before the aide is employed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021


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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BARRENECHEA, JOHANA
FACILITY NUMBER: 434411683
VISIT DATE: 11/15/2021
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The OFF-LIMIT AREAS are the main house and the kitchen area(all knives and scissors are out of reach)(cabinets and drawers have child safety locks). There is a shed in the backyard that is locked and inaccessible. There are no bodies of water or firearms on the premises.

The ON-LIMIT AREAS are the play yard which is fenced with a gate that opens inward/ outward and the classroom(garage). The classroom has safe furniture appropriate for children. The sink area has pumping soap for the children to wash hands and hand sanitizer plus personal hand towel per child. The trash bins are covered with a lid and there is a small TV for the children to watch cartoon. All the disinfectants and cleaning solutions are stored in the top shelves in the kitchen, so the children do not have access to them. The licensee prepares lunch, breakfast, and snacks for the children in the kitchen. In terms of milk: none is being served at this time. All children drink water and they each have a water bottle with their names on them. The licensee refills the water bottles on a as needed basis. The classroom is equipped with toys, books, chairs, and tables that are appropriate for the age group. The children have cubbies with their names on them. The play yard has a play structure with a slide and swing (Licensee is planning to buy a new play structure). They are all in good working conditions and there is a soft mat material around the play structure which can absorb falls.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The Family Child Care Home has a fully charged fire extinguisher 3A-40-BC, working smoke detector, working carbon monoxide, telephone and fully stocked first aid kits. The furniture around the classroom is child proof and the toys are stored in safety bins that can be easily accessed by the children. A Type A citation was given to the Licensee for Health and Safety Code Section 1596.871 which states all employees or volunteers must have a criminal record clearance prior to being employed at a child care home or facility. S3 has 24 hours to obtain a criminal background check and shall not be allowed on the premises until he or she receives a clearance.
The Licensee completed the Health and Safety training, CPR/First Aid is current. The licensee is following the immunization laws and has completed the mandated reporter training. The director conducts and documents fire and disaster drills twice a year and the last conducted drill was on May 2021. All required forms are posted and visible for public view.At 1:30PM LPA (Sabina Dodoo) reviewed 5 children’s files and 3 staff files, facility file and documented on LIC 857 and LIC 859. There is a current roster available for review and copy obtained. The fire drill disaster plan was last done in May of 2021. The staff interview was completed with the Center Director Johana Barrenechea at 3:40PM.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BARRENECHEA, JOHANA
FACILITY NUMBER: 434411683
VISIT DATE: 11/15/2021
NARRATIVE
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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

To improve the quality and value of the new inspection process, a survey will 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/process.

Licensee was reminded that all adults 18 and over living or working in Child Care Center, 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 Child Care Center. 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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BARRENECHEA, JOHANA
FACILITY NUMBER: 434411683
VISIT DATE: 11/15/2021
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LPA discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There is one deficiency cited today. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview conducted with Licensee(Barrenechea) at 4pm. This report shall remain on file for the next 3 years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
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