<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908214
Report Date: 10/15/2019
Date Signed: 10/15/2019 10:48:50 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:SEGOVIA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
103908214
ADMINISTRATOR:SEGOVIA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 709-9639
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:14CENSUS: 4DATE:
10/15/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 PM
MET WITH:Guadalupe SegoviaTIME COMPLETED:
11:00 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 this date, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Case Management inspection. LPA met with Licensee, Guadalupe Segovia, to discuss Community Care Licensing (CCL) regulations. Also present during this inspection was Licensee's sister/assistant, Socorro Avila. LPA Slaughter discussed the purpose of the inspection with Licensee and obtained a census. Based on interviews conducted, and evidence heard, it was determined Licensee violated the personal rights of children in Licensee's daycare. Licensee spoke inappropriately to daycare children.

A print out of Title 22, Division 12, Chapter 1, Article 06. Continuing Requirements, 102423 Personal Rights was provided to Licensee for review.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiencies are found: See 809 D

Any Licensing reports indicating a Type A deficiency shall be posted immediately. Copies of this licensing report are to be provided to the parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).

A copy of this report and appeal rights were provided to Licensee.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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 2
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: 10/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2019
Section Cited

1
2
3
4
5
6
7
Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This
8
9
10
11
12
13
14
requirement was not met as evidenced by listening to a recording where Licensee spoke inappropriately to daycare children. This posses an immediate risk to the health, safety and/or personal rights of children in care.
8
9
10
11
12
13
14
of children in care. Licensee will communicate to LPA what she learned from the videos. POC is due by end of day on Wednesday, October 16, 2019.

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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2