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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908214
Report Date: 07/25/2019
Date Signed: 07/25/2019 01:51:48 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:SEGOVIA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
103908214
ADMINISTRATOR:SEGOVIA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 709-9639
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:14CENSUS: 12DATE:
07/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Guadalupe SegoviaTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Angelica Slaughter and Candis Rodriguez conducted an unannounced Annual/Random inspection. LPAs met with Licensee Guadalupe Segovia. Licensee's assistant Blanca Segovia was also present during this inspection. LPAs conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. Accessible areas of the home are the living room, family room, den, dining room, kitchen, hallway bathroom and back yard. All other rooms in the home are made inaccessible by sliding chain latches at the top of the doors. No pets observed during today's inspection. There are no "bodies of water". There are no firearms in the home. No poisons were observed on the premises. Licensee was reminded that cleaning compounds, medications and other hazardous items are to be inaccessible to children. There is a fireplace, however, it's not used during day care hours. There are no stairs in the home. 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 (559) 709-9639 and number was verified. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunization for pertussis, measles and influenza for herself and her assistant. Fire drills are conducted 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. Licensee signed LIS531 verifying all cleared adults associated to the home. 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’s Pediatric CPR/First Aid expires 04/28/20. Licensee has not completed AB 1207 Mandated Reporter training. Licensee will complete required training once it is available in Spanish. 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. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Friday; 5:30 AM – 6:00 PM and as arranged.

Continued on 809-C

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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: SEGOVIA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 103908214
VISIT DATE: 07/25/2019
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 provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website. LPA also discussed safe sleep with Licensee.



Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D) Site Visit Notice to be posted on the parent board.

Licensee was provided a copy of appeal rights, a copy of this report, as well as form LIC 9213.



THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
LIC809 (FAS) - (06/04)
Page: 2 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: SEGOVIA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 103908214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2019
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by today's inspection.
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Licensee stated she will replace the broken child proof latch in the kitchen and will install a latch in the drawer in the bathroom. Licensee will take pictures and submit to CCL by the POC due date.
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LPAs observed dangerous items under the kitchen sink: Comet cleaner. Also in the bathroom drawer a razor was found in a drawer and toothpaste was on the bathroom counter. This posses a potential risk to the health, safety and/or personal rights of children in care.
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Type B
07/26/2019
Section Cited
CCR
102417(d)
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Operations of a Family Child Care Home. The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by: LPAs observed the yellow, tunnel slide connected to the wood play structure coming apart. Connecting bolts were missing from several areas of the slide.
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Licensee stated she will remove the slide from the wood play structure and order parts to repair the slide or order a new slide. Licensee will take pictures and submit to CCL by the POC due date.
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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: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3