103910599-12-7-2022-04-CC-AGIN-CLVVPB-20221207153629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103910599
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:36:39 PM

Document Has Been Signed on 12/07/2022 03:36 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:	MEDINA, CLAUDIA FAMILY CHILD CARE		FACILITY NUMBER:	103910599
ADMINISTRATOR:	MEDINA, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 853-8822
CITY:	FRESNO	STATE: CA	ZIP CODE:	93728
CAPACITY:	14	CENSUS: 4	DATE:	12/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Claudia Medina		TIME COMPLETED:	03:45 PM

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On 12/7/22 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensee, Claudia Medina and hours of operation are Monday through Friday hours are 6:00 AM to 6:00 PM.

LPA toured the home inside and outside. Licensee had 4 children in care. Licensee confirmed that the living room, dining room, kitchen, bathroom, bedroom 1 bedroom 3 and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locked doors There are no firearms or ammunition on the premises. Detergents, poisons, cleaning compounds, medication and other hazardous items were inaccessible to daycare children.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are stairs and a fireplace in the home both are made inaccessible by a locked door or locked fireplace screen. Stair have a physical door making it inaccessible to the daycare children. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 853-8822.

There are two infants enrolled during today’s inspection. 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. Provider physically checks on sleeping infants every fifteen minutes however admitted to not documenting for any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing (see 809D). Infants can be visually observed through an open door if sleeping in a separate room. 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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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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Document Has Been Signed on 12/07/2022 03:36 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: MEDINA, CLAUDIA FAMILY CHILD CARE	FACILITY NUMBER: 103910599
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: 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 Two infants in care with inconsistent documentation of safe sleep.which poses potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/21/2022
	Plan of Correction
1 2 3 4	Licensee agrees to submit evidence of current documentation of safe sleep for the two infants by 12/21/22 POC date.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. 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 all children enrolled in care were missing LIC 627 Consent for Medical treatment form which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/21/2022
	Plan of Correction
1 2 3 4	icensee agrees to submit evidence of copies of signed LIC627 Consent to treatment documentation for all daycare chidlren by 12/21/22 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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/07/2022 03:36 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: MEDINA, CLAUDIA FAMILY CHILD CARE	FACILITY NUMBER: 103910599
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based onr ecord review, the licensee did not comply with the section cited above in 3 out of 5 children missing immunization records. which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/21/2022
	Plan of Correction
1 2 3 4	Lincensee agrees to submit copy of updated immunization records for the 3 enrolled daycare children.

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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: MEDINA, CLAUDIA FAMILY CHILD CARE	FACILITY NUMBER: 103910599
	VISIT DATE: 12/07/2022

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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. LPA observed and discussed best practice to do a clean up to assure outdoor areas are clean and safe for children to use. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were incomplete with missing immunizations for 3 out of 6 children. LPA also observed LIC 627 consent to medical treatment form also missing from children’s files (see 809D for further.) Licensee completed the Mandated Reporter Training on 06/2021. Licensee provided a copy of the pediatric CPR/First Aid training expiring in 12/2023. Licensee and assistant understands they must have immunization records on file for (TDAP) pertussis and (MMR) measles and was verified by LPA. Licensee did not have over eight children enrolled during the day of the inspection and did not have an assistant present.

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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

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