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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900058
Report Date: 08/05/2019
Date Signed: 08/05/2019 10:59:30 AM

COMPREHENSIVE INSPECTION
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:CAVALLA,JANICEFACILITY NUMBER:
103900058
ADMINISTRATOR:CAVALLA,JANICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 436-0325
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:14CENSUS: 7DATE:
08/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janice Cavallo, LicenseeTIME COMPLETED:
11:10 AM
NARRATIVE
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LPA Pete Espinoza made an unannounced Annual/Random inspection. LPA met with Janice Cavallo, Licensee, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no firearms in this facility. Swimming pool is fenced per regulation. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked. There is no fireplace. Fire extinguishers and smoke/carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. Where children less than five years old are in care, stairs are fenced or barricaded. The home provides safe toys, play equipment, and materials. The licensee is present in the home and ensures that children in care are supervised at all times. Children are not left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. The licensee and other personnel as specified have completed training on preventive health practices including pediatric
Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.
Licensee provided proof of required immunization (Pertussis/Measles/influenza and/or written declaration declining flu shot).
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.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CAVALLA,JANICE
FACILITY NUMBER: 103900058
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2019
Section Cited
HSC
1596.8662(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider or employee of a licensed child day care facility shall complete the mandated reporter training. This requirement is not met as
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Licensee will mail to Fresno Regional Office copy of Certificate indicating successful completion of required mandated reporter Training by 08/26/2019
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evidenced by a review of records conducted during today’s inspection. Licensee was unable to provide proof of completion for mandated reporter training
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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 deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: CAVALLA,JANICE
FACILITY NUMBER: 103900058
VISIT DATE: 08/05/2019
NARRATIVE
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Licensee will update each child's PM 286 (Blue Card).

LPA & licensee discussed the Community Care Licensing website, Lead Safety and Mandated Reporter Training: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN. LPA and Licensee discussed Safe Sleep and Licensee was provided A Child Care Provider’s Guide to Safe Sleep.

The following is cited per chapter 3, Title 22, Div. 12 of the CCR: (see page 2) Copy of appeal Rights left with center representative/licensee.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

To view e-learning modules: https://ccld.childcarevideos.org/
Advocate e-mail: childcareadvocatesprogram@dss.ca.gov
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3