153800237-9-3-2019-04-CC-JTHN-BFNTJ2-20190903144538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153800237
Report Date: 09/03/2019
Date Signed: 09/03/2019 02:45:46 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:	HOME AWAY FROM HOME DAY CARE		FACILITY NUMBER:	153800237
ADMINISTRATOR:	ANCHORDOQUY, LORRAINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 393-3327
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	14	CENSUS: 8	DATE:	09/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Lorriane Anchordoquy - Licensee		TIME COMPLETED:	02:50 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	Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Licensee Lorraine Anchordoquy who provided a tour of the home, as shown on the facility sketch. Also present were licensee's assistants Kristina Stewart and Krista Marquez. There are no firearms or “bodies of water” on the premises. Off limits areas are made inaccessible by use of locked doors and spinning door knob covers. Required forms are posted. Smoke and carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. Safe toys and play equipment were observed. There is a working telephone. Adequate supervision was provided during this visit. Outdoor play areas are fenced and supervised by the licensee or care giver. Licensee has one small dog that is is. Licensee accepts full liability for any action taken by family pet. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Children’s records contain all emergency information specified by regulation. There are no excluded individuals present at this home. All adults who reside or work in the home have a criminal record clearance or exemption as indicated on Facility Roster. Licensee has current pediatric CPR and First Aid that expires on 09/15/20. Licensee has proof of Child Abuse Mandated Reporter training, completed 11/24/18. Licensee is aware of safe sleep concepts for infants in care. Licensee maintains proof of immunization, for herself, within the family child care home. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is aware that forms and updated information may be obtained on the Community Care Licensing Division's website (www.ccld.ca.gov). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Licensee reported that currently she does not have any children enrolled requiring IMS (Continued on LIC809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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: HOME AWAY FROM HOME DAY CARE	FACILITY NUMBER: 153800237
	VISIT DATE: 09/03/2019

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Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Business hours are Monday-Friday, 7:00 AM- 5:00 PM, and as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

In exit interview the licensee was advised of appeals rights and was provided with Appeals Rights.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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: HOME AWAY FROM HOME DAY CARE	FACILITY NUMBER: 153800237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/03/2019 Section Cited	1 2 3 4 5 6 7	Alterations to Existing Buildings or Grounds. Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: 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.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by inspection conducted by LPA. On this date, LPA observed an infant asleep within a play yard in an "off limit" bedroom. This poses a potential risk to the Health and Safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

LIC809 (FAS) - (06/04)

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