103906269-4-12-2023-04-CC-AGIN-CQTVJA-20230412162825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103906269
Report Date: 04/12/2023
Date Signed: 04/12/2023 04:28:37 PM

Document Has Been Signed on 04/12/2023 04:28 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MONTIEL, NICOLE FAMILY CHILD CARE		FACILITY NUMBER:	103906269
ADMINISTRATOR:	MONTIEL, NICOLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 321-3656
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	14	CENSUS: 10	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Nicole Montiel		TIME COMPLETED:	04:45 PM

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On 4/12/23 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced Annual Required Inspection and was met by Licensee, Nicole Montiel. LPA toured the indoors and outdoor areas that are accessible to daycare children. Days and hours of operation are Monday-Friday from 7:00 AM - 4:30 PM.

LPA toured the home inside and outside and a census of 10 children was taken. Current facility sketch reviewed, and Licensee confirmed that the kitchen, bathroom, living room, family room, dining room, and outdoor play yard are used for providing care and are accessible to children. Master bedroom, Bedroom 1 and 2 are off-limits and made inaccessible by use of doorknob covers. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the family room and is made inaccessible by furniture and a screen. Fireplace is not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the cell phone number is (559) 321-3656.

LPA discussed Safe Sleep Regulations with licensee. Licensee is aware that for each infant in care, cribs and play yards are to be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Licensee physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. continue 809C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MONTIEL, NICOLE FAMILY CHILD CARE	FACILITY NUMBER: 103906269
	VISIT DATE: 04/12/2023

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. During today’s inspection LPA observed 10 children in care with no assistant who arrived shortly thereafter capacity of the license was not being maintained in this brief duration of time while children were napping. (see 809 D)

LPA reviewed a sample of children’s files and observed files to be complete with emergency information as required. Licensee’s Mandated Reporter completed on 5/4/22 and assistant completed it on 04/12/23. Licensee and staff (2) had the pediatric CPR/First Aid with expiration of 08/30/24. A review of records indicates that Licensee and Staff (2) had immunization records for pertussis, measles and flu on file at the facility.

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.

Incidental Medical Services (IMS) is not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

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

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/12/2023 04:28 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MONTIEL, NICOLE FAMILY CHILD CARE	FACILITY NUMBER: 103906269
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2023
	Plan of Correction
1 2 3 4	Licensee will read and review capacity and ratio regulations for a large family child care home. Licnesee to write a statement regarding capacity date, sign and submit to LPA Gibson by plan of correction date 4/26/23

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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