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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910980
Report Date: 02/21/2023
Date Signed: 03/03/2023 10:04:38 AM

Document Has Been Signed on 03/03/2023 10:04 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910980
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-0174
CITY:SANTA NELLASTATE: CAZIP CODE:
95322
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria HernandezTIME COMPLETED:
03:45 PM
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On 02/21/2023 Licensing Program Analyst (LPA) Julie Baptista and Licensing Program Manager (LPM) Cynthia Brannon conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Hernandez. Days and hours of operation are 6:00 AM to 6:00 PM Monday through Friday. The home has working telephone service and LPA confirmed the phone number is (831) 588-0174.
LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that front room, bathroom and side yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of gates. The outdoor play area in the side yard is fenced and there are no hazards to children present. There is one cat. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed.
LPA discussed the safe sleep regulations 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.
Continued on 809-C
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Julie Baptista
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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Document Has Been Signed on 03/03/2023 10:04 AM - It Cannot Be Edited


Created By: Julie Baptista On 02/21/2023 at 02:43 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: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243910980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of clothing stacked in an area off of hallway, that leads to the restroom children use, a tall and wide package leaning against the wall and dried ketchup on the children's table. Licensee did not comply with the section cited above. This poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 03/07/2023
Plan of Correction
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Licensee was previously cited on 12/2/2021 for the same citation. Per licensee, she will clean and ensure home is clean and orderly. She will place items in bins and place the bins in the garage. A return inspection will be conducted.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file reviews, licensee did not comply with the section cited above. Licensee participated in a First Aid/CPR online class. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
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Per licensee, she will enroll and pay for an accepted First Aid/CPR class. Licensee will provide a copy of paid registration. LPA will conduct a return inspection.
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:Cynthia Brannon
LICENSING EVALUATOR NAME:Julie Baptista
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023


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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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243910980
VISIT DATE: 02/21/2023
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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. 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. Licensee’s Mandated Reporter Training was completed on 06/14/2022. Licensee’s pediatric CPR/First Aid has expired. Licensee took her last class online. LPA informed LIcensee CPR/1st aid class must be taken in person. Per Licensee, she will enroll into and take a valid in-person CPR/1st aid class within two weeks.
All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee 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.
Incidental Medical Services (IMS) are not currently being provided. 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.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.
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/process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). Appeal rights were provided.
Exit interview conducted and report was reviewed with the facility representative Maria Hernandez.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Julie Baptista
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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