103909887-12-28-2021-04-CC-KMWS-CA5QXL-20211228113343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103909887
Report Date: 12/28/2021
Date Signed: 12/28/2021 11:34:03 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:	MUNIZ, TERESA FAMILY CHILD CARE		FACILITY NUMBER:	103909887
ADMINISTRATOR:	MUNIZ, TERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 355-0899
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	14	CENSUS: 4	DATE:	12/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Teresa Muniz		TIME COMPLETED:	11:45 AM

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 December 28, 2021 Licensing Program Analyst (LPA), Kari McWilliams conducted an unannounced Annual Required Inspection and was met by Licensee, Teresa Muniz. Also present was Staff #1 (Leticia Miranda). Days and hours of operation are Monday through Friday 6:00AM-5:30PM. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen, bathroom and living room and daycare room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of child safety devices. 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. 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) 355-0899. There is currently one infant in care. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Continued on 809-c

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliams	TELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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: MUNIZ, TERESA FAMILY CHILD CARE	FACILITY NUMBER: 103909887
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based onobservation, the licensee did not comply with the section cited above in the bathroom that the children in care use has black mold/mildew on the ceiling which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2022
	Plan of Correction
1 2 3 4	Licensee states that the bathroom is being remodeled on January 15 or January 22, 2022 to fix the leak that is causing the mold; Licensee stated that she provide pictures of the completed construction by the above POC date.

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record review and interview, the licensee did not comply with the section cited above in Licensee confirmed that they have not been completing the 15 minute checks while children under 24 months are sleeping which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/28/2021
	Plan of Correction
1 2 3 4	LPA provided Licensee with needed form and Licensee states that she will complete forms for the 15 minute checks on children under 24 months of age starting December 28, 2021.

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) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliams	TELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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: MUNIZ, TERESA FAMILY CHILD CARE	FACILITY NUMBER: 103909887
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in Licensee and assistant have not completed the Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/14/2022
	Plan of Correction
1 2 3 4	Licensee states that her and her assistant will complete the Mandated Reporter Training and send LPA certificates of completion by POC date.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on receord review and interview, the licensee did not comply with the section cited above in Licensee could not provide proof of her and her assistants immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/14/2022
	Plan of Correction
1 2 3 4	Licensee states that she will contact her doctor and obtain needed documentation and provide proof of immunizations to LPA by above POC 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 Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliams	TELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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: MUNIZ, TERESA FAMILY CHILD CARE	FACILITY NUMBER: 103909887
	VISIT DATE: 12/28/2021

NARRATIVE

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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. Licensee states that the park across the street is also used. 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 and staff #1 need to complete Mandated Reporter Training. Licensee’s pediatric CPR/First Aid expires on 08/22/2022. A review of records indicates that all employees and/or volunteers need to provide immunization records 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. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) are not currently being provided. 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: 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 deficienc(y)ies is/are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.
Continued on 809-c

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliams	TELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

LIC809 (FAS) - (06/04)

Page: 7 of 7

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: MUNIZ, TERESA FAMILY CHILD CARE	FACILITY NUMBER: 103909887
	VISIT DATE: 12/28/2021

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee Teresa Muniz.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliams	TELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

LIC809 (FAS) - (06/04)

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