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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543906923
Report Date: 12/03/2021
Date Signed: 12/03/2021 05:06:06 PM

Document Has Been Signed on 12/03/2021 05:06 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:CODER, STACEY FAMILY CHILD CAREFACILITY NUMBER:
543906923
ADMINISTRATOR:CODER, STACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 636-2161
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Stacey Coder - Licensee TIME COMPLETED:
05:20 PM
NARRATIVE
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On 12/03/21 Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Annual Required Inspection. LPA was met by Licensee Stacey Coder. Also present was Staff #1.

LPA toured the home inside and outside and a census was taken. Licensee’s current facility sketch was reviewed, and Licensee confirmed that the kitchen, dining room area, bathroom, living room, master bedroom & bedroom #4 are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of spinning doorknob covers. 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. The home has working telephone service and LPA confirmed the phone number is (559) 636-2161.

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, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Licensee was unable to provide proof of physically checking on sleeping infants every fifteen minutes and documenting signs of distress. Licensee was unable to provide proof of Individual Infant Sleeping Plan completion for Child #1. 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 and there are no hazards to children present. Capacity as specified on the license is being maintained (see next page, LIC8090-C)

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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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Document Has Been Signed on 12/03/2021 05:06 PM - It Cannot Be Edited


Created By: Jessika Thompson On 12/03/2021 at 02:51 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: CODER, STACEY FAMILY CHILD CARE
FACILITY NUMBER: 543906923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 3 out of 3 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will begin completing sleeping logs for Child #1, Child #3, and Child #5, and that she will do so on an ongoing basis for all infants enrolled. A blank sample sleep log was provided to Licensee today. Licensee stated she will maintain proof on site of ongoing sleep log completion for Child #1, Child #2, Child #5 by 12/31/21.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 1 out of 2 employee files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee indicated she will to attempt obtain proof of immunization for Staff #1 by 12/31/21, and provide proof of immunization to the Fresno Community Care Licensing Office by the POC due date.
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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 12/03/2021 05:06 PM - It Cannot Be Edited


Created By: Jessika Thompson On 12/03/2021 at 02:51 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: CODER, STACEY FAMILY CHILD CARE
FACILITY NUMBER: 543906923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

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 in 3 out of 9 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will ensure all children's files contain completed and signed Identification and Emergency Information (LIC700) forms going forward. Licensee stated she will submit a copy of completed LIC700's for Child #6, Child #7, and Child #8, to the Fresno Community Care Licensing Office by 12/31/21.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) 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 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 in 4 out of 9 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will ensure all children's files contain record of immunization going forward. Licensee stated she will submit proof of immunization for Child #6, Child #7, Child #8, and Child #9 to the Fresno Community Care Licensing Office by 12/31/21.
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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 12/03/2021 05:06 PM - It Cannot Be Edited


Created By: Jessika Thompson On 12/03/2021 at 02:51 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: CODER, STACEY FAMILY CHILD CARE
FACILITY NUMBER: 543906923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 record review, the licensee did not comply with the section cited above in 1 out of 1 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will ensure she completes an Individual Sleeping Plan for all infants up to 12 months of age going forward. Licensee stated she will submit a copy of a completed Individual Sleeping Plan for Child #1 to the Fresno Community Care Licensing Office by 12/31/21.
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:Diana deLeon
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/03/2021 05:06 PM - It Cannot Be Edited


Created By: Jessika Thompson On 12/03/2021 at 02:51 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: CODER, STACEY FAMILY CHILD CARE
FACILITY NUMBER: 543906923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 8 out of 8 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will begin completing PM 286 forms for all non-school-age children enrolled. Licensee stated she will submit completed PM 286's for Child #1-Child #8 to the Fresno Community Care Licensing Office by 12/31/21.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 6 out of 9 files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Licensee stated she will ensure all children's files contain completed and signed Affidavit Regarding Liability Insurance (LIC282) forms going forward. Licensee stated she will send a copy of completed LIC282's for Child #2, Child #3, Child #6, Child #7, Child #8 and Child #9 to the Fresno Community Care Licensing Office by 12/31/21.
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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021


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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: CODER, STACEY FAMILY CHILD CARE
FACILITY NUMBER: 543906923
VISIT DATE: 12/03/2021
NARRATIVE
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LPA reviewed a sample of children’s files and observed that several files were missing or incomplete. Licensee’s Mandated Reporter Training was completed on 3/1/21. Licensee’s pediatric CPR/First Aid expires on 3/22/23. A review of records indicates that the licensee has immunization records on file for herself; however, Licensee was unable to provide proof of measles & whooping cough immunization for Staff #1.

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.

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.



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. .

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

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.

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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