103900153-6-11-2019-04-CC-SNAO-BD2R8D-20190611124745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103900153
Report Date: 06/11/2019
Date Signed: 06/11/2019 12:47:57 PM

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:	CARMONA,PHYLLIS		FACILITY NUMBER:	103900153
ADMINISTRATOR:	CARMONA,PHYLLIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 299-5549
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	14	CENSUS: 12	DATE:	06/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Phyllis Carmona		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/11/2019 at 9:15 AM, Licensing Program Analysts (LPAs), Stephanie Navarro and Luisa Gavoutian, conducted an unannounced annual/random inspection. LPAs met with Licensee, Phyllis Carmona. LPAs conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Licensee stated the fenced far north east side of the backyard is off limits to daycare children. LPAs advised Licensee to update facility sketch and provide to Community Care Licensing (CCL) Fresno Regional office. Facility sketch LIC999a provided to Licensee during inspection. There are no pets, "bodies of water". LPAs observed Licensee's firearm that is located in a locked box. Licensee has no ammunition in stock at this time, but is stored in a separate locked box located in a separate room. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children as it is barricaded by an insert. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone and number was verified. Adequate supervision is being provided during this inspection. Children are supervised when outside in the unfenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee was unable to provide her immunization record for Measles (MMR) during inspection. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles. 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. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee and Assistant #1 Pediatric CPR/First Aid are current and expire on 4/20/21. Licensee was unable to provide AB1207 Mandated Reporter Certificates for herself and staff. Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Stephanie Navarro	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

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: CARMONA,PHYLLIS	FACILITY NUMBER: 103900153
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/11/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Facility Administration - 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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Licensee was unable to provide AB1207 Mandated Reporter Training Certificates for herself and staff. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2019
	Plan of Correction
1 2 3 4	Licensee agreed to have all staff complete AB1207 Mandated Reporter Training and submit certificate of completions to Community Care Licensing (CCL) Fresno Regional office by 6/28/2019.

Type B

Section Cited

HSC

1597.622(c)

Facility Administration - Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Licensee was unable to provide her immunization record for Measles (MMR). This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2019
	Plan of Correction
1 2 3 4	Licensee agreed to sumbit her immunization record for Mealses (MMR) to Community Care Licensing (CCL) Fresno Regional office by 6/28/2019.

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: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Stephanie Navarro	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

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: CARMONA,PHYLLIS	FACILITY NUMBER: 103900153
	VISIT DATE: 06/11/2019

NARRATIVE

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Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice.

Hours of operation are Monday – Friday; 07:15am -5:30pm.

Incidental Medical Services (IMS) policy was discussed. Licensee stated she is not providing IMS services at this time. 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

LPAs & 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 left a copy of A Child Care Provider’s Guide to Safe Sleep.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations the following deficiencies are cited on LIC 809-D.

Licensee was handed a copy of appeal rights. Exit interview was conducted with Phyllis Carmona.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

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

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Stephanie Navarro	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

LIC809 (FAS) - (06/04)

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