103909806-11-17-2021-04-CC-RGUZ-C8URDK-20211117115603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103909806
Report Date: 11/17/2021
Date Signed: 11/17/2021 11:56:12 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:	RODRIGUEZ, ANDREA FAMILY CHILD CARE		FACILITY NUMBER:	103909806
ADMINISTRATOR:	RODRIGUEZ, ANDREA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 399-6160
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	14	CENSUS: 6	DATE:	11/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Andrea Rodriguez		TIME COMPLETED:	12:15 PM

NARRATIVE

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On 11/17/2021 Licensing Program Analyst (LPA) Robert Gutierrez, conducted an unannounced Annual Required Inspection and was met by Licensee, Andrea Rodriguez. Also present was Staff #1 (S1). Days and hours of operation are Monday – Friday 6:00 AM – 6:00 PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that great room, dining room, kitchen, hallway bathroom, bedroom #4 and the back yard are used for providing care and are accessible to children. Inspecting the backyard LPA observed a two play structures not securely anchored to the ground. LPA then observed dog feces, Licensee stated due to the weather children have not gone outside. All other rooms are off-limits and made inaccessible by use of door knob locks and a children safety gate installed at the base of the stairs. LPA did not inspect kitchen or restroom drawers/cabinets as they contained properly functional preventative entry devices on them. There is no swimming pool or other bodies of water on the premises. 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.

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. Stairs are fenced or barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 399-6160.

There are currently two infants in care. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are 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.

Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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: RODRIGUEZ, ANDREA FAMILY CHILD CARE	FACILITY NUMBER: 103909806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in that she did not have a personnel record for S1. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/10/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with an employee packet that contains LIC 9052, LIC 508, the link for the mandated reporter training link etc.. Licensee stated S1 shall complete these forms/training's and send copies to the Fresno Regional Office by the given due date.

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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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: RODRIGUEZ, ANDREA FAMILY CHILD CARE	FACILITY NUMBER: 103909806
	VISIT DATE: 11/17/2021

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Provider 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.

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. 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 documents fire drills being conducted once at least every six months. Licensee has a current roster of children in care. Licensee’s Mandated Reporter Training was completed on 04/26/2021. Licensee’s pediatric CPR/First Aid expires on 07/31/2023. License provided her immunization records for influenza, pertussis and measles. Licensee does not have any paperwork for S1.

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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC809 (FAS) - (06/04)

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