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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902196
Report Date: 04/13/2023
Date Signed: 04/24/2023 04:42:15 PM

Document Has Been Signed on 04/24/2023 04:42 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HOOKS, ELAINE FAMILY CHILD CAREFACILITY NUMBER:
153902196
ADMINISTRATOR:HOOKS, ELAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 302-1394
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Elaine HooksTIME COMPLETED:
03:20 PM
NARRATIVE
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On 04/13/2023, Licensing Program Analysts (LPAs), Jose Penate and Martha De Haro, conducted an unannounced Annual Required Inspection and were met by Licensee’s Assistant Laila Haulcy. Also present was licensee’s niece. Days and hours of operation are Monday – Friday, 7am to 6 pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed rooms accessible for children to use is the daycare room, living room, bathroom, dining room, kitchen, and backyard. During outdoor inspection, LPAs observed gardening tools and a plastic gas can containing gas accessible to children in care. Licensee immediately removed gas can from the area and placed it in a locked shed. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. During inspection, LPAs observed hand sanitizer and medication that was accessible to the children in the living room as well as clutter (high piled cooking items-high stored toys-etc). In the kitchen, LPAs observed kitchen knives on the kitchen counter as well as a can of paint on the floor. LPAs also observed clutter on the kitchen counter. In addition, LPAs observed cleaning products, tools, and a paint can in the laundry room, that are accessible to children in care.



There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. The home has working telephone service and LPA confirmed the phone number is (661) 302-1394.

LPA and licensee discussed Safe Sleep Regulations. LPAs observed an empty bottle in one of the cribs with no child present. LPAs discussed regulations with Licensee and made her aware that cribs and play yards are to be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard.

continued on LIC 809-C
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:08 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. During inspection LPA's observed a female adult assisting with children in care. Licensee stated that the female adult assisted her years ago but as of now is not associated and is not approved by the department. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Female adult left the facilty immediately once licensee arrived to residence. (POC Cleared)
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:08 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During inspection LPA observed gas can, laundry detergent, and medication that is accessible to children in care. This which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will remove all items in living room, kitchen and backyard that should not be accessible to children in care.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee stated that she has completed training but unfortuantely she could not provide certificate on todays date. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will gather certificate of completed and will submit to CCL by POC date. (4/21/23)
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
Page: 3 of 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:08 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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. Licensee was unable to provide immunization record for assistant. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will submit proof of immunizations to CCL by POC. (4/21/23)
Section Cited
General Provisions and Definitions
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
Page: 4 of 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:08 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

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. Licensee was unable to provide current child roster during inspection.This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will submit current child roster by POC.(4/21/23)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee has not completed form LIC 9227 for infants in care that are 12 months of age and/or younger. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will complete form and discuss with parents. Once completed form will be submitted to CCL by POC. (4/21/23)
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
Page: 5 of 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:08 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records revie, the licensee did not comply with the section cited above. Licensee was unable to provide 15 minute sleep check for all (4) infants in care. Licensee was aware of the form but has not completed one. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Licensee will complete form for all infants under 24 months of age and document checks while infants are sleeping.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Licensee did not comply by leaving approved assistant in care with 11 children. Licensee stated she was only gone for 20 mins. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Licensee will create a plan to ensure she will not leave assistant alone with more than 8 children in care.
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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


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Page: 6 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196
VISIT DATE: 04/13/2023
NARRATIVE
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Provider is aware to physically check on sleeping infants every fifteen minutes but she was unaware that she needed to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Individual Infant Sleeping Plan is to be completed for each infant up to 12 months of age upon enrollment. LPA discussed with licensee, Infants up to 12 months of age shall be placed on their backs for sleeping. While discussing safe sleep regulations, licensee confirmed that she has not completed LIC 9227 forms for infants in care that are 12 months of age or younger.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. During inspection, LPAs observed 3 car seats accessible to the children in the living room and kitchen. LPAs informed licensee that car seats should not be accessible to children and licensee removed them from the area immediately. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensees Mandated Reporter Training was completed on 7/17/2020, licensee stated she recently completed the training with the union but is unable to gather her completed certificate. Licensee’s pediatric CPR/First Aid expires on 02/26/2025. A review of records indicates that Assistant was unable to provide immunization records (MMR, Tdap, Influenza, and TB). All adults who reside or work in the home do not have a criminal record clearance or exemption. During inspection, LPAs observed an uncleared adult present at the facility, assisting with children in care.

Incidental Medical Services (IMS) are not currently being 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are being cited on the attached LIC 809-D.

Exit interview conducted and report was reviewed with Licensee, Elaine Hooks.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
Page: 13 of 14
Document Has Been Signed on 04/24/2023 04:42 PM - It Cannot Be Edited


Created By: Jose Penate On 04/13/2023 at 01:54 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: HOOKS, ELAINE FAMILY CHILD CARE
FACILITY NUMBER: 153902196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
The family day care home shall maintain documention of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Licensee was unable to provide immunization record for assistant. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Licensee will submit proof of immunizations to CCL by POC. (4/21/23)
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
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