103903823-10-9-2019-04-CC-RMAS-BGSN73-20191009101204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103903823
Report Date: 10/09/2019
Date Signed: 10/09/2019 10:12:21 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:	OLIVO, CICILY FAMILY CHILD CARE		FACILITY NUMBER:	103903823
ADMINISTRATOR:	OLIVO, CICILY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 917-8636
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	14	CENSUS: 6	DATE:	10/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cicily Olivo		TIME COMPLETED:	10:00 AM

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	Licensing Program Analyst (LPA), Rene Mancinas JR, conducted an unannounced annual inspection and was met by Licensee, Cicily Olivo. LPA toured the home inspecting areas accessible to children and a census was taken. Licensee confirmed that the kitchen, dining room, living room, children’s bathroom, and backyard are used for providing care and are accessible to children. This is a two-story home, with a safety gate installed at the bottom of the stairs, making the staircase and second floor of the home inaccessible to children in care. There are no swimming pools or other bodies of water on the premises. The outdoor play area in the backyard is fenced. Firearms and ammunition are properly locked and stored [separately] in accordance to Title 22 regulations. Safe toys and play equipment are observed. Cleaning compounds, medication and other hazardous items are made inaccessible. No poisons were observed during inspection. The fireplace located in the living room and is not in use during daycare hours. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Licensee has two dogs that are kept in an area inaccessible to children. Licensee understands the liability and safety of children around pets and accepts responsibility. Capacity as specified on the license is being maintained. Licensee’s pediatric CPR/First Aid expires on 02/28/2020. Mandated Reported Training was completed on 02/19/19. A review of records indicates that immunization records are in file for children and adults. Licensee has a current roster of the children and maintains emergency information and forms as required. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. 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. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and notification of parents rights poster are posted on the wall located near the front door entrance of the home. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Hours of operation are Monday-Friday, 7:30 am to 5:30 pm, or as arranged. (Continued on 809-C).

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

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: OLIVO, CICILY FAMILY CHILD CARE	FACILITY NUMBER: 103903823
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/31/2019 Section Cited	1 2 3 4 5 6 7	The licensee shall document the drills, including the date and time of each drill. This requirement was not met as evidenced during today's inspection of facility files review. (See 809-C for further). This poses
	8 9 10 11 12 13 14	a potential risk to the health, safety, and personal right of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

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: OLIVO, CICILY FAMILY CHILD CARE	FACILITY NUMBER: 103903823
	VISIT DATE: 10/09/2019

NARRATIVE

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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which provides access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, and Forms and Regulations.

During today’s inspection, the following deficiency was observed;

During inspection of facility files review, Licensee could not produce proof of a fire/disaster drill being conducted and documented within the last six months, as required per regulations. The last fire/disaster drill documented was dated for 02/19/19.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the above deficiency is being cited today. (See 809-D page for further). Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

LIC809 (FAS) - (06/04)

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