103909421-9-1-2021-04-CC-NHER-C6FQUD-20210901122835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103909421
Report Date: 09/01/2021
Date Signed: 09/01/2021 12:28:47 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:	VALENZUELA, JAMIE FAMILY CHILD CARE		FACILITY NUMBER:	103909421
ADMINISTRATOR:	VALENZUELA, JAMIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 473-3685
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	14	CENSUS: 5	DATE:	09/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Jamie Valenzuela		TIME COMPLETED:	12:45 PM

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On 09/01/21 Licensing Program Analyst (LPA) Nancy Her, conducted an unannounced Annual Required Inspection and was met by Licensee Jamie Valenzuela. Also present was Staff #1 (Teresa Whitaker). Days and hours of operation are 24 hours a day, 7 days a week.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen, dining room, bedroom 1, bathroom, laundry room and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of spinning door knob covers and locked doors while there are children in care. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. 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 phone number is (559) 473-3685.

LPA discussed Safe Sleep Regulations with licensee. There is to be one crib or play yard 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 to not be swaddled while in care. Provider will physically check on sleeping infants every fifteen minutes and document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants will need to be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

Continued on 809-C

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Nancy Her	TELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: VALENZUELA, JAMIE FAMILY CHILD CARE	FACILITY NUMBER: 103909421
	VISIT DATE: 09/01/2021

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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. There are two small dogs. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 02/09/19. Licensee’s pediatric CPR/First Aid expires on 09/14/21. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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) are 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 deficiency is 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: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Nancy Her	TELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: VALENZUELA, JAMIE FAMILY CHILD CARE	FACILITY NUMBER: 103909421
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/10/2021 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by records review conducted during today’s inspection. Licensee's mandated reporter training was completed on 02/09/19 and has not bween renewed. This poses a potential risk to health, safety, or personal rights of children in care.	8 9 10 11 12 13 14
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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: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Nancy Her	TELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

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