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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216295
Report Date: 04/27/2022
Date Signed: 04/27/2022 11:45:42 AM

Document Has Been Signed on 04/27/2022 11:45 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ARRIAGA FAMILY CHILD CAREFACILITY NUMBER:
566216295
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Azaria ArriagaTIME COMPLETED:
12:00 PM
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On April 27, 2022 at 9:33 AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an announced Pre-licensing inspection. LPA spoke to applicant Azaria Arriaga and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Applicant and LPA toured the facility inside and outside. One other fingerprint cleared adult was present. There were no children in care at the time of the inspection.

The home is a three bedroom, two bath single story home. The applicant will use the living room, kitchen, dining room, two bedrooms, one will be used for the applicant's daughter and the other will serves as the main playroom, one bathroom, and front patio for the day-care. The 1 bedroom, 1 bathroom, garage/laundry room, and backyard are off limits and are made inaccessible to children in care. There are age appropriate toys, teaching materials, and furnishings in good condition and free of hazards. The backyard will be off limits and is inaccessible to children in care. Applicant is currently remodeling the backyard and the facility sketch reflects the off limits area. LPA reminded applicant to contact CCL once construction is completed for approval to utilize area for childcare. The front patio is fully enclosed with a fenced wall. Applicant has age appropriate toys in the front yard readily accessible to children. LPA did not observe any toxins/hazardous items accessible to children. The bathroom to be used for children in care was observed to be clean and sanitary. LPA observed two small dogs in the sideyard which is gated. Applicant reported that the dog's vaccinations are up to date.

LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher was observed with a purchase date of 04/20/2022. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA had applicant test dual smoke and carbon monoxide detector in the home and were found operational. All adults in the home are fingerprint cleared.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 566216295
VISIT DATE: 04/27/2022
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LPA observed the home to be orderly. No bodies of water were observed on site. Applicant stated that there are no guns or ammunition in the home. Detergents and cleaning compounds are stored out of reach of children. Applicant states the home does not currently have liability insurance. LPA informed applicant that parents will need to sign a waiver for the liability insurance if insurance is not obtained (applicant was provided form- LIC 282).

Applicant's Pediatric First Aid/CPR certificate is valid until 07/28/2022. AB1207 Mandated Reporter certificate is valid until 02/11/2024. LPA reviewed Grant Deed to verify control of property. Preventative Health and Safety and Nutrition Training completed on 04/09/2022.

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.html

LPA issued the applicant updated samples of state required forms to be kept in the children's records. LPA also discussed and provided Guidelines to Safe Sleep and Effects of Lead Exposure leaflets. Applicant was provided information from PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect and LIC 9227 (Infant Sleeping Plan). Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant was made aware of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.



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/inspection-process.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
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: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 566216295
VISIT DATE: 04/27/2022
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Applicant was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with applicant 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.

LPA reviewed COVID-19 guidelines/resources with applicant (RAST Technical Assistance Visit completed). LPA also reminded licensee to continue monitoring the CCLD website for COVID-19 updates and guidance. Applicant will implement pre-screening checks, promoting prior hand washing and continuously disinfecting throughout the day.



License to operate a Small Family Child Care facility is effective today, 04/27/2022. Once licensed, the licensee is required to comply with the terms and limitations stated on the license.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with applicant, Azaria Arriaga.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
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