103910143-3-3-2023-04-CC-AGIN-CPL3DK-20230303170936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103910143
Report Date: 03/03/2023
Date Signed: 03/03/2023 05:09:49 PM

Document Has Been Signed on 03/03/2023 05:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	BRAVO, MARYURI FAMILY CHILD CARE		FACILITY NUMBER:	103910143
ADMINISTRATOR:	BRAVO, MARYURI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 352-2768
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	14	CENSUS: 4	DATE:	03/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Maryuri Bravo		TIME COMPLETED:	05:15 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 03/03/2023, Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced Annual Inspection. LPA was greeted by Licensee Maryuri Bravo who accompanied LPA on a tour of the home, inside and outside, LIcensee had four children present at todays inspection. Licensee made adjustment to her facility sketches (LIC 999) LPA obtained a copy. The areas of the home that are accessible to the daycare children are the play room, nook, living room, dining room, bedroom 1 and bedroom 3, hallway bathroom and fenced backyard. “Off-limits” rooms are made inaccessible by child safety gate, doorknob spinners, and lever locks. Licensee operating hours are Monday through Friday 7:30 AM to 5:00 PM. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. There are no firearms present in the home. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medications and other hazardous items are inaccessible to children. 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 the home. There is a fireplace with a glass enclosure made inaccessible in the living room. Fireplace is not in use during day care hours. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 352-2768 There are 6 infants enrolled. LPA discussed Safe Sleep Regulations with licensee specifically speaking to license capacity 4 infants in care at a time. There should be 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. 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. Infants up to 12 months of age are placed on their backs for sleeping. LPA provided consultation regarding sleep plan, Licensee understands the use of the Infant Sleep LIC9227 form. Continue 809 C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BRAVO, MARYURI FAMILY CHILD CARE	FACILITY NUMBER: 103910143
	VISIT DATE: 03/03/2023

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. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with the immunizations. Licensee completed the Mandated Reporter Training on 3/2023. Licensees’ pediatric CPR/First Aid expires on 05/01/23. Currently Licensee had no employee present but is able to provide evidence of 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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 03/03/2023 05:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BRAVO, MARYURI FAMILY CHILD CARE	FACILITY NUMBER: 103910143
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(d)(1)

Infant Safe Sleep

The provider shall place infants up to 12 months of age on their backs for sleeping. This requirement shall not apply if the infant has a medical exemption from a licensed physician that allows for an alternative sleep position. The exemption shall be attached to the Individual Infant Sleeping Plan [LIC 9227 (3/20)] and contain the following criteria: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in infants 0-12 month enrolled did not have a sleep plan on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2023
	Plan of Correction
1 2 3 4	Licensee agrees to provide LPA evidence of completed sleep plans for infants 0-12 months by plan of correction 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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC809 (FAS) - (06/04)

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