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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808038
Report Date: 03/18/2022
Date Signed: 03/18/2022 12:37:25 PM


Document Has Been Signed on 03/18/2022 12:37 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:DERMER'S CREATIVE CARE TOOFACILITY NUMBER:
103808038
ADMINISTRATOR:DERMER, SANDRA SUEFACILITY TYPE:
830
ADDRESS:8855 N. CHESTNUTTELEPHONE:
(559) 325-6913
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:22CENSUS: 16DATE:
03/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Marisol RodriguezTIME COMPLETED:
01:00 PM
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On March 18, 2022 Licensing Program Analyst (LPA) Brannon met with Assistant Director/Lead Teacher Marisol Rodriguez. During today's visit, LPA conducted staff interviews, received a copy of sign in/out log, reviewed child and staff files.

LPA received an Unusual Incident/Injury Report (LIC 624) form. Infant 1 (I1) had access to a spray bottle with Fabuloso. There were three staff in infant classroom #1 with an estimated census of 10 infants. One staff was changing diapers, another staff was standing by the sink and another staff was cleaning when the incident took place. Staff 1 (S1) had just changed I1 and place infant on the floor, S2 was standing near the sink area, S3 was cleaning and putting toys away. S3 saw I1 with the spray bottle containing Fabuloso. Interviews with staff reflect that infant had a hand on the spray device and nozzle in mouth. Staff did smell Fabuloso in infant's mouth. Assistant Director/Lead Teacher was notified, Poison Control was contacted and informed staff of behavior and signs to look for when an infant ingests Fabuloso. Infant's mouth was rinsed out and followed the guidelines provided by Poison control. Per staff, I1 did not display any symptoms.

Interviews reflect that the information provided by staff did not align. Areas that aligned was that I1 had the spray bottle with Fabuloso, placed spray nozzle in mouth, there were three staff in the classroom when incident occurred and one staff was changing diapers.

I1 had access to a spray bottle containing Fabuloso. Per staff, Fabuloso is used to clean tables. The spray bottle was located near changing table. Fabuloso is not used to sanitize changing table. LPA was informed that a bleach/water solution is used to sanitize diaper changing pad. While the infant classroom was within ratio, the required supervision of infants was not met. Infant had access to the spray bottle with Fabuloso and was able to place spray nozzle into mouth.

CONTINUED ON FOLLOWING PAGE
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DERMER'S CREATIVE CARE TOO
FACILITY NUMBER: 103808038
VISIT DATE: 03/18/2022
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of their appeal rights.

LPA Brannon informed licensee, Sandra Dermer, that this report dated March 18, 2022 document one Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Brannon informed the licensee, Sandra Dermer, to provide a copy of this licensing report dated March 18, 2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with licensee, Sandra Dermer.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2022 12:37 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: DERMER'S CREATIVE CARE TOO
FACILITY NUMBER: 103808038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/25/2022
Section Cited

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Responsibility for Providing Care and Supervision for Infants. In addition to Section 101229, the following shall apply: Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement was not met as evidenced by interviews findings.
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 I1 had access to a spray bottle containing Fabuloso and was able to place spray nozzle into mouth before staff was aware that infant had the spray bottle. Staff smelled infant's breath which smelled like Fabuloso. This is an immediate personal rights, health and safety risk to infants in care.
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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 DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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