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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900956
Report Date: 08/21/2019
Date Signed: 08/21/2019 11:01:11 AM

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:ALVAREZ,AMALIAFACILITY NUMBER:
103900956
ADMINISTRATOR:ALVAREZ,AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 399-3046
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:14CENSUS: DATE:
08/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Amalia AlvarezTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA), Rene Mancinas JR, conducted an unannounced annual inspection. LPA met with Licensee, Amalia Alvarez, whom is Spanish speaking. LPA conducted a tour of the home and inspected areas accessible to day care children. There is are pets at this home. Licensee understands the responsibility of any action taken by pet involving day care children. There are no "bodies of water" or firearms in this home. This is a single-story home and so there are no staircases that pose a risk to children in care. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the unfenced play area. Capacity as specified on the license is being maintained. Licensee maintains documentation of immunizations for the children. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). 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. Pediatric CPR/First Aid are current and expire on 10/2019. 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.

LPA informed Licensee of Safe Sleep practices for infants and how to provide Safe Sleep environments. LPA informed Licensee to visit the Department’s website (www.ccld.ca.gov) for updates and changes related to licensing regulations and procedures.

Hours of operation are Monday – Friday; 06:00am -07:00pm. (Continued on 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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 4
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: ALVAREZ,AMALIA
FACILITY NUMBER: 103900956
VISIT DATE: 08/21/2019
NARRATIVE
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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 & licensee discussed the Community Care Licensing website. 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.



During today’s inspection the following deficiencies were observed;
Upon entry into the home and inspection of the living room area, LPA observed a 7-month-old infant, sitting in a stationary activity center/jumper. LPA also observed a baby bouncer, not being used by children. LPA informed Licensee that such items are not allowed in a licensed facility and/or to be used by day care children as they pose a risk to the health, safety, and personal rights of children in care. LPA provided Licensee with examples of items allowed in day care facilities.

During inspection and review of facility files, Licensee could not produce proof of fire/disaster drills being conducted and documented at least once every six months as required by regulation. LPA informed Licensee that such poses a potential risk to the health, safety, and personal rights of children in care.

During inspection and review of facility files, Licensee could not produce proof of immunization requirements set forth by regulation. LPA informed Licensee that she will need to obtain proof of Pertussis, Measles, and Flu (required annually, but optional if written statement provided yearly to the Department) immunizations and submit to CCLD. LPA informed that this poses a potential risk to the health, safety, and personal rights of children in care.
End of deficiencies observed.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the above deficiencies are being cited today. (See 809-D for further). Appeal rights were provided.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ALVAREZ,AMALIA
FACILITY NUMBER: 103900956
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited
HSC
1597.622(a)(1)
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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.
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Licensee stated she will obtain proof of required immunization and submit proof to LPA/CCLD Fresno by POC date.
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This requirement was not met as evidenced during today's inspection (See 809-C for further). This poses a potential risk to the health, safety, and personal rights of children 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: ALVAREZ,AMALIA
FACILITY NUMBER: 103900956
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2019
Section Cited
ILS
102417(d)
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Operation of a Family Child Care Home: The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced during today's inspection. (See 809-C for further). This poses a
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Licensee removed the items upon notice. Licensee provided with information regarding items allowed in licensed facilities. Deficiency cleared during today's inspection.
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potential risk to the health, safety, and personal rights of children in care.
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Type B
09/20/2019
Section Cited
CCR
102417(g)(9)(A)
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Operation of a Family Child Care Home: Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement was not met as evidenced during today's inspection. (See 809-C for further). This poses a
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Licensee was informed of regulation requirements and agreed to conduct and document a fire drill as soon as practical. Licensee agreed to submit proof to LPA/CCLD Fresno by POC date.
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potential risk to the health, safety, and personal rights of children 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4