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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243902819
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:14:43 PM

Document Has Been Signed on 07/20/2021 03:14 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:KIRK, HERMINIA FAMILY CHILD CAREFACILITY NUMBER:
243902819
ADMINISTRATOR:KIRK, HERMINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 455-0706
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Herminina KirkTIME COMPLETED:
03:30 PM
NARRATIVE
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An unannounced Annual Required inspection was conducted today by Licensing Program Analysts, Norma Lomeli and Araceli Gibson. Present during the inspection was licensee, Licensee’s Assistant, Gabriela Morfin and eleven day-care children. Licensee is the only person who resides in the home. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance or exemption.
  • The licensee and licensee’s assistant have current Pediatric Plus CPR and First Aid that expires on August 8, 2022. Preventative Health Practice was completed and confirmed at pre-licensing inspection.
  • The home is clean and orderly, with heating and ventilation for safety and comfort.
  • Observed children size furniture, safe toys and books for the children in care. A current roster of children in care is maintained. Verified that immunizations records are maintained and license updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative.
  • The licensee ensures that children in care are supervised at all times.
  • Licensee states there are no firearms, ammunition or poisons in the home.
  • Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children.
  • No fireplace in the home.
  • Facility has 3A40BC fire extinguishers and smoke detectors that meet State Fire Marshall standards. Facility has a working carbon monoxide detector that meets the statutory requirements.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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: KIRK, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 243902819
VISIT DATE: 07/20/2021
NARRATIVE
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  • No bodies of water observed in or on the premises.
  • Licensee states she maintains licensed capacity at all times.

LPA & licensee discussed the Community Care Licensing website: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Hours or operation are Monday through Saturday from 4:45 AM to 11:00 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee understands children may not be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence.

In exit licensee is advised to post the Notice of Site Visit for 30 days and retain evaluation report for 3 years.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are cited: (see LIC809-D):

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW. THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.



To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/20/2021 03:14 PM - It Cannot Be Edited


Created By: Norma Lomeli On 07/20/2021 at 02:12 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: KIRK, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 243902819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
HSC
1596.8662(4)(b)(1

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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. This requirement was not met as evidenced by LPAs at the time of the inspection, licensee stated that she has not updated the certification that expired in February 2021.
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Licensee and licensee's assistant will update the Mandated Reporter Training available at www.ccld.ca.gov and provide Fresno CCL office with new certifications on or before
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Licensee understands that she and her assistant must update the Mandated Reporter Training and have proof of certification every two years.
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August 6, 2021.
Type B
08/06/2021
Section Cited
HSC101417(g)(A)

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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. This requirement was not met as evidenced by licensee could no provide fire drill documentation. This poses a risk to the health and safety of the children in care.
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Licensee agrees to conduct a fire and disaster drill and send proof to Fresno CCL office on or before August 6, 2021. Licensee agrees to conduct and document fire drills at least once every 6 months.
Type B
08/06/2021
Section Cited
HSC
102418(a)

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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement was not met as evidenced by LPAs child records review. This poses a risk to the health and safety of the children in care.
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Licensee agrees to provide Fresno CCL office with proof of children immunizations on or before August 6, 2021. Licensee was provided with LIC857.
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:Norma Lomeli
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2021


LIC809 (FAS) - (06/04)
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