493008276-11-2-2023-01-CC-ASTR-CX7SPK-20231102140316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493008276
Report Date: 11/02/2023
Date Signed: 11/02/2023 02:03:23 PM

Document Has Been Signed on 11/02/2023 02:03 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	ARISTIZABAL, ALETA FCCH		FACILITY NUMBER:	493008276
ADMINISTRATOR:	ARISTIZABAL, ALETA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 483-7130
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 6	DATE:	11/02/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Aleta Aristizabal		TIME COMPLETED:	02:15 PM

NARRATIVE

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An annual required inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Licensee, Aleta Aristizabal (L1). L1 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 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 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. During today's inspection L1 listed the adults living in the home. One adult listed, Adult 5 (A5) was not listed on the facility roster. LPA confirmed with the Community Care Licensing Santa Rosa Regional Office that although A5 does have an eligible clearance to work in an adult/senior facility, A5 does not have an eligible clearance to live/work in a Family Child Care home facility. L1 stated that A5 did complete the LiveScan fingerprinting and did show proof of a completed form LIC9163 dated 07/24/23, stating that she did not follow up to confirm that A5's criminal record clearance was associated to her facility.

During the inspection the home was toured inside and outside. During today’s visit L1 and an assistant were supervising 2 infants, 3 preschool age children and 1 school age children, for a total of 6 children and operating within the licensed capacity and ratio requirements. L1 provided a current roster of children in care as required. LPA verified that the children present were listed on the roster. The facility’s operating hours are Monday – Friday 7:00AM - 5:30PM. The floor plan submitted by the licensee was reviewed and verified. The off-limit areas of the home are the converted garage. outdoor laundry room, and two outdoor sheds. The converted garage and laundry room were made inaccessible by child safety gates and the sheds by lock and key. The home appears to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children.

Continued on LIC 809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ARISTIZABAL, ALETA FCCH	FACILITY NUMBER: 493008276
	VISIT DATE: 11/02/2023

NARRATIVE

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Licensee stated that any poisons stored on the premises are in the key locked shed outside. The fireplace has been made inaccessible with a child safety gate. LPA observed a working smoke detector, carbon monoxide detector and a fire extinguisher, rated at least 2A10BC that appeared to be charged, were in the home. The licensee has conducted an emergency drill within the past six months; last drill was documented on 08/22/23. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. Five children's records were reviewed. Facility and personnel files were reviewed and contained required records.

LPA discussed the safe sleep regulations, including not using sleep sacks 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.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ARISTIZABAL, ALETA FCCH	FACILITY NUMBER: 493008276
	VISIT DATE: 11/02/2023

NARRATIVE

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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 CARE tools, please send email inquiries 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.

The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Aleta Aristizabal.

LPA Strother informed licensee, Aleta Aristizabal that this report dated 11/02/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Strother informed the licensee to provide a copy of this licensing report dated 11/02/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/02/2023 02:03 PM - It Cannot Be Edited

Created By: Amy Strother On 11/02/2023 at 01:14 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ARISTIZABAL, ALETA FCCH	FACILITY NUMBER: 493008276
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/02/2023

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one out 5 adults living living in the home. Based on record review, A5 does not have a criminal record clearance for child care and is not associated to the Licensee's home which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/03/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will have A5 re-fingerprint and verify that A5 has an eligible child care clearance, associated to her facility prior to A5 returning to live in the home. Licensee provided LPA with a written statement, stating that she will verify A5's clearance and association to her license prior to A5's return to the home.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Alexis Hollon

LICENSING EVALUATOR NAME:

Amy Strother

LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

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