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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909806
Report Date: 12/19/2019
Date Signed: 12/19/2019 12:48:53 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:RODRIGUEZ, ANDREA FAMILY CHILD CAREFACILITY NUMBER:
103909806
ADMINISTRATOR:RODRIGUEZ, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 399-6160
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:14CENSUS: 11DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Andrea RodriguezTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Rene Mancinas JR, conducted an unannounced annual inspection and met with Licensee, Andrea Rodriguez. Also present were two minor assistants, and adult assistant, Olivian Azua. 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 the backyard are used for providing care and are accessible to children. There are no swimming pools or other bodies of water on the premises. There are no firearms or ammunition present at this facility. Safe toys and play equipment are observed. Cleaning compounds, medication and other hazardous items are made inaccessible. No poisons were observed during inspection. This is a two-story home. There is no fireplace at this home. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire/disaster drills are conducted and documented at least once every six months as required per regulations. There are pets at this home. Licensee understands the responsibility of any action taken by pet involving day care children. Licensee’s pediatric CPR/First Aid expires on 04/20/2021. A review of records indicates that immunization records are in file for children and licensee. Licensee had a current roster of children in care 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 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, 06:00 am to 06:00 pm, or as arranged.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 4
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: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806
VISIT DATE: 12/19/2019
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 Licensing Forms and Regulations. LPA provided information regarding Safe Sleep practices for infants, including, but not limited to, placing infants to sleep on their back and placing infants to sleep in only cribs or playpens, which are to be free of any loose articles during sleeping periods.

During today’s inspection, Licensee requested LPA to inspect the downstairs bedroom to list it as an area accessible for day care children to utilize. LPA inspected the bedroom, which consisted of two approved baby cribs and a changing station. The room was deemed safe by LPA and is listed an area accessible to children in care as of today’s date (12/19/2019).

Per California Health and Safety Code and Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited today. (See 809-D for further). Appeal rights were provided to Andrea Rodriguez.

Deficiencies observed;

Upon entry into the home, Licensee greeted LPA and allowed him into the home. LPA asked Licensee to confirm the number of children in care. Licensee counted 7 children located in the downstairs area of the home. LPA confirmed 7 children were present downstairs. LPA observed a safety gate that was not secured in a manner to prevent children five years of age or younger from accessing the staircase and second story of the home. LPA informed Licensee that he would need to inspect the staircase and upstairs area, due to the safety gate not being secured as required per regulation. Once upstairs, LPA discovered assistant, Olivia Azua, upstairs caring for 3 children, two of them whom were infants. When Licensee was asked why children and assistant were upstairs, Licensee stated she “believed” she was “out of ratio.” The children were located in the Licensee’s master bedroom, which is an area not inspected by the Department and listed as “off-limits.”

End of Deficiencies observed.

(See following 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806
VISIT DATE: 12/19/2019
NARRATIVE
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Due to the above findings, LPA is issuing a Type A deficiency for conduct inimical to the health, morals, welfare, and/or safety of children in care and the people of this state, in which Licensee attempted to withhold true information regarding the number of children in care. This poses an immediate risk to the health, safety, and personal rights of children in care.

LPA is also issuing a Type B deficiency for the 3 children located in an off-limits area of the home. This poses a potential risk to the health, safety, and personal rights of children in care.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to 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. A completed signed copy of the LIC 9224 will need to be completed by each parent for each child in care.

This report shall be posted for 30 days from today’s inspection date. LIC 9213 Notice of Site Inspection is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2019
Section Cited

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Conduct Inimical: Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the poeple of this state. This requirement was not met as evidenced during today's inspection and LPA
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observations and Licensee's statement admitting she had hid children and assistant from LPA due to belief that she was out of ratio. This is an immediate risk to the health, safety, and personal rights of children in care.
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Child Care Office during an Informal Meeting, which is determined to be scheduled at a later date.
Type B
12/19/2019
Section Cited

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Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement was not met as evidenced during today's inspection and LPA observations.
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This is a potential risk to the health, safety, and personal rights of children in care.
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Licensee agreed to provide written statement to Fresno Regional
Child Care Office during an Informal Meeting, which is determined to be scheduled at a later date.
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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4