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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909018
Report Date: 06/07/2021
Date Signed: 06/07/2021 06:44:34 PM

Document Has Been Signed on 06/07/2021 06:44 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ARMACK, EVELYN FAMILY CHILD CAREFACILITY NUMBER:
103909018
ADMINISTRATOR:ARMACK, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 790-8143
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
06/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Evelyn ArmackTIME COMPLETED:
06:50 PM
NARRATIVE
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On 06/07/21, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced annual inspection and met with Licensee, Evelyn Armack. Also present were her Assistants. A tour of the home was conducted and a census was taken. Off limit rooms are made inaccessible by locked doors and a baby gate. Areas of the home accessible to the children are the designated day care room, bathroom and back yard. One small dog was observed during today's inspection. There was an above ground swimming pool that was not fenced per the regulations. Licensee stated they just put the pool up yesterday and were having a fence installed tomorrow. Daycare children are not currently allowed in the backyard until fence is installed. Licensee was made aware that a citation and civil penalty would be issued for this violation. There are no firearms in the home. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fire extinguisher, smoke detector, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. Licensee ensures that children in care are supervised at all times. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children.

There is currently only one infant in care over 12 months. LPA discussed Safe Sleep Regulations with Licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping. There are no objects hanging above or attached to the crib or play yard. Infants in care are not swaddled. Licensee physically checks on sleeping infants every 15 minutes and documents any signs of distress, to include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants up to 12 months of age are placed on their backs for sleeping.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ARMACK, EVELYN FAMILY CHILD CARE
FACILITY NUMBER: 103909018
VISIT DATE: 06/07/2021
NARRATIVE
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Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained. Staff-child ratios were maintained. A sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee and all employees and/or volunteers have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee's Mandated Reporter Training (MRT) was last completed on 06/17/18 and must be retaken. LPA discussed required Mandated Reporter Training to be completed by 06/14/21. Assistant's MRT is up to date and was last completed on 06/09/19. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee and Assitant's pediatric CPR and First Aid expires on 12/2021.

Incidental Medical Services (IMS) are not currently provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA information line at (800) 514-0301 (voice), (800) 514-0383 (TDD), and website link: https://www.ada.gov/childqanda.htm. http://www.ada.gov/childqanda.htm

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms, and Regulations.

LPA also discussed the issue of overdue licensing fees. Licensee stated she would be paying the overdue fees as soon as possible.

Business hours are Monday through Friday 6:30 AM to 6:30 PM and other hours as arranged.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ARMACK, EVELYN FAMILY CHILD CARE
FACILITY NUMBER: 103909018
VISIT DATE: 06/07/2021
NARRATIVE
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Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiencies were found
(809D):

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), appeal rights, and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

For Type A violations, upon receipt of the licensing report, Licensee must:
Post the LIC 809 or LIC 9099

**Upon receipt of a Type A violation, Licensee shall post the Type A report immediately and for the next 30 days. Copies of the Licensing report shall be provided to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (Acknowledgement of Receipt of Licensing Reports - LIC 9224). A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of the LIC 9224 was provided to Licensee.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2021 06:44 PM - It Cannot Be Edited


Created By: Angelica Slaughter On 06/07/2021 at 05:54 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ARMACK, EVELYN FAMILY CHILD CARE
FACILITY NUMBER: 103909018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2021
Section Cited
CCR
102417(g)(5)(A)

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Operation of a Family Child Care Home - All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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Licensee is having a fence installed as soon as possible. Licensee plans to have a fence installed immediately. Licensee will drain pool if the above plan is not acceptable. LPA discussed the importance of contacting CCLD prior to installing any kind of pool or any similar body of water.
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This regulation was not met as evidenced by: There was an above ground pool in the backyard that was not fenced. This is an immediate health and safety and/or personal rights risk to children in care. A $500 civil penalty was assessed.
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Licensee will be in contact with LPA to determine how they will proceed with correcting this issue. Licensee will also watch CCLD video on Bodies of Water Requirements in Child Care by end of day 06/08/21.
Type B
06/14/2021
Section Cited
HSC1596.8662(4)(b)(1)

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Mandated Reporter Training - On or before March 30, 2018..is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...shall complete renewal mandated reporter training every two years..the initial mandated reporter training. This requirement was not met as
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Licensee stated she will complete her required Mandated Reporter Training by the POC due date of 06/14/21. Licensee will submit a copy of the certificate to CCLD by end of day on 06/14/21.
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evidenced by: Licensee could not find a current copy of her Mandated Reporter Training. Last Annual report showed a date of 06/17/18 as last date completed.
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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:Diana deLeon
LICENSING EVALUATOR NAME:Angelica Slaughter
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2021


LIC809 (FAS) - (06/04)
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