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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543904138
Report Date: 04/11/2022
Date Signed: 04/11/2022 02:49:35 PM

Document Has Been Signed on 04/11/2022 02:49 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:CHAVEZ, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
543904138
ADMINISTRATOR:CHAVEZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 793-1239
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
04/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Juliana Chavez and Guadalupe ChavezTIME COMPLETED:
03:15 PM
NARRATIVE
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On 4/11/2022, Licensing Program Analyst (LPA), Ruby Ocegueda conducted an unannounced Annual Required Inspection and was met initially by staff #1 and then by Licensee Guadalupe Chavez. Licensee is Spanish Speaking. Days and hours of operation are Monday through Friday from 5:30 AM - 5:00 PM or other hours as arranged.

Upon arrival, LPA was met by adult #1 who stated she/he lived at the facility and indicated that he/she had not obtained criminal record clearance. Licensee was not home initially but upon her arrival, also confirmed that adult #1 lived at the facility. Adult #1 let LPA in the facility where staff #1 was providing care and supervision to children in the day care room. LPA toured the facility inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the day care room, one attached bathroom and a closet are used for care. All other rooms are off-limits and are in the main part of the home. The day care room requires entrance through the accessible play yard and not the main home living area. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Upon inspection of the accessible side yard, LPA observed that there was an unlocked and open storage closet where there were poisons (Amdro Mole and Gopher Bait and Ortho Home Defense Insect Killer). Licensee confirmed that the storage closet was left open by her husband and LPA reviewed inaccessibility as licensee indicated that the children didn’t go to this area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible inside the facility.

The fireplace located in the living room is made inaccessible by a screen and will not be in use during daycare hours. Children do not have accessible to the living room area. 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. LPA inspected the play equipment outside and reminded licensee that all equipment should be clean and inspected regularly for cobwebs and any defects such as chipped paint. The home has working telephone service and LPA confirmed the phone number is (559) 793-1239. Report continued to 809-C

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
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 04/11/2022 02:49 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 04/11/2022 at 12:06 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: CHAVEZ, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 543904138

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
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. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

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. Licensing Program Analyst (LPA) Ocegueda observed poisons (Ortho Insect Killer and Amdro Mole and Gopher bait) in an unlocked and open storage closet on the side yard which was also accessible. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2022
Plan of Correction
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Today, Licensee placed a zip tie on the storage closet outside making it inacessible and will place a lock on it as soon as possible. Proof of locked closet will be submitted to the Department by POC date 4/12/2022.
Type A
Section Cited
CCR
102370(d)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review and interview, the licensee did not comply with the section cited above. Upon arrival, LPA Ocegueda was greeted by adult #1 who stated she/he lived there and had not been fingerprinted. Licensee stated that she had difficulty finding an open facility where adult #1 could be fingerprinted during the pandemic in 2020, but later forgot to have adult #1 fingerprinted as places re-opened. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2022
Plan of Correction
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 Licensee stated she will have adult #1 fingerprinted as soon as possible and will provide proof of Live Scan form and receipt to the Department. Adult #1 called the local police Department and they informed adult #1 that he/she could walk in on 4/13/2022. Deficiency will be cleared when adult #1 received criminal record clearance by the Department.
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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2022 02:49 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 04/11/2022 at 12:06 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: CHAVEZ, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 543904138

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 record review, the licensee did not comply with the section cited above. During file review of licensee and staff #1 files, LPA Ocegueda observed that licensees Mandated Reporter Training had expired on 2/19/2022 and that staff #1 had never completed the training. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/11/2022
Plan of Correction
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Licensee stated that she and staff #1 will be completing the required training and submit proof of completion to the Department by POC date 5/11/2022.
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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2022 02:49 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 04/11/2022 at 12:06 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: CHAVEZ, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 543904138

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above. Licensee stated she did not realize that three out of hte four children's files were missing the required signed portion of LIC 995A. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/11/2022
Plan of Correction
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 Licensee stated she would have parents sign the LIC 995A form and would review her files again for accuracy. Proof of LIC 995 for child #1, child #2, child #3 will be submitted to the Department by POC 5/11/2022.

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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022


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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: CHAVEZ, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 543904138
VISIT DATE: 04/11/2022
NARRATIVE
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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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report 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. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

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: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
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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: CHAVEZ, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 543904138
VISIT DATE: 04/11/2022
NARRATIVE
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LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care. In the crib, LPA observed a bumper pad and blankets and in the play pen, LPA observed an infant over the age of 12 months that was playing with toys, a bottle and had a small blanket with him/her. LPA reviewed the regulation with licensee. Staff #1 was observing infant #1 while he/she was in the play pen playing. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and LPA reviewed the requirement to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Today, Licensee could not find updated sleep logs for the two infants in care. Infants sleep in the day care room where they are directly supervised while sleeping. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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. The outdoor play area in the backyard is fenced. 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. Three out of Four children’s’ files were missing Signed Notification of Parents Rights (LIC 995A). Three out of Four Children’s Files were missing Consent for Emergency Medical Treatment (LIC 627). Two out of Four Files were missing required Immunization records. LPA reviewed the missing information with licensee. Licensee’s Mandated Reporter Training (AB1207) expired on 2/19/2020 and Staff #1 had never completed the required Training. Licensee’s pediatric CPR/First Aid expires on 10/19/2023. A review of records indicates that all employees and/or volunteers have immunization records of pertussis and measles. Licensee stated she did not obtain proof of influenza vaccine, but stated that she and staff #1 did take it.

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.


Report continued to 809-C
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC809 (FAS) - (06/04)
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