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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406571
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:55:49 PM


Document Has Been Signed on 06/22/2022 03:55 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:VISON, DOLORESFACILITY NUMBER:
073406571
ADMINISTRATOR:VISON, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 291-2672
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 7DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Dolores Vison TIME COMPLETED:
04:00 PM
NARRATIVE
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On 6/22/22 at 1:30 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection Dolores Vison Family Childcare Home. LPA met with licensee Dolores and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours are Monday to Friday 7:00 AM to 6:00 PM. Present in the home at time of inspection were licensee, 3 infants, 3 preschool children and 1 school-age child.

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.

Indoor Space: At 1:40 PM A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 3A40BC fire extinguisher, working smoke alarm and carbon monoxide detector in the home.

The OFF-LIMIT areas are the entire second floor, laundry room and garage. These areas are inaccessible to children in care by closed locked doors, gates and visual supervision. IN-USE Family room, dinning room, kitchen, backyard and downstairs bathroom. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and draws with latches. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are no pets and arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: VISON, DOLORES
FACILITY NUMBER: 073406571
VISIT DATE: 06/22/2022
NARRATIVE
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Outdoor Space: At 2:00 PM LPA toured the outdoor area and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water.

Children files and Facility file were reviewed. LPA discussed with licensee to complete pediatric CPR and first aid and missing 2 out of 7 children's files.

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 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.

The following Technical Violations and deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Dolores Vison.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 06/22/2022 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: VISON, DOLORES
FACILITY NUMBER: 073406571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2022

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 in by not have an updated Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2022
Plan of Correction
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By POC date Licensee with submit mandated reporting training for Child Care Providers to LPA
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 record review, the licensee did not comply with the section cited above that licensee has not renewed certification for ediatric cardiopulmonary resuscitation and pediatric first aid which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2022
Plan of Correction
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By POC date Licensee will submit certification for pediatric CPR and first aid to LPA.

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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7


Document Has Been Signed on 06/22/2022 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: VISON, DOLORES
FACILITY NUMBER: 073406571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

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 2 out of 7 persons did not have children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2022
Plan of Correction
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7