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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153805531
Report Date: 05/13/2019
Date Signed: 05/13/2019 12:59:17 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:CASA HOGAR JACOBOFACILITY NUMBER:
153805531
ADMINISTRATOR:JACOBO, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 454-6591
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY:14CENSUS: 2DATE:
05/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Bertha JacoboTIME COMPLETED:
01:30 PM
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An unannounced Annual/Random inspection is conducted by Licensing Program Analyst (LPA) Gloria Reyes. LPA met with Licensee, Bertha Jacobo and her assistant, Griselda Palos. Licensee is Spanish speaking. The individuals who reside in the home are the licensee, licensee's spouse, licensee's adult daughter and licensee's granddaughter. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight. LPA toured the facility inside and outside. The licensee cares for children in the large day care room and attached half bath. The “off limits” rooms are as follows: the master bedroom and two hallway bedrooms and have knob covers or locks on the doors. No bodies of water on site. No firearms or ammunition are in the home. Storage areas for detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children. Poisons are locked. Fireplaces and open face heaters are screened to prevent access by children. Fire extinguisher, smoke detector, and carbon monoxide detector are operable and in place. The home is kept clean and orderly with heating and ventilation for safety and comfort. There are no stairs in this home. The home provides safe toys, play equipment, and materials. The licensee is present in the home and ensures that children in care are supervised at all times. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her absence. The licensee maintains capacity specified on the license. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children and a copy is secured. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. There are no excluded individuals in the home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to home or having contact with children in care. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. (see next page)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CASA HOGAR JACOBO
FACILITY NUMBER: 153805531
VISIT DATE: 05/13/2019
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The licensee and other personnel as specified have completed training on preventive health practices including Pediatric CPR and Pediatric First Aid are current and expires on 05/22/19 for Bertha Jacobo, Gloria Pena and Griselda Palos. Licensee will provide a copy of updated recertification cards upon completion of class. LPA verified that the required immunzations have been completed by staff. LPA verified that the required Mandated Child Abuse (AB 1207) training has been completed by staff. Family pets, two small dogs observed and are inaccessible to day care children by means of safety gate. Licensee has 1 bird cage containing a total of 2 small birds in the backyard. Licensee understands that the area around and underneath bird cage must be kept clean when day care children are present.

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: http://www.ada.gov/childqanda.htm

LPA provided information on Safe Sleep guidelines to the licensee. The practice of safe sleep for infants in care was reviewed. LPA provided Licensee with handouts on "Safe Sleep Regulations Concepts", "Individual Infant Sleeping Plan", “Safe Sleep in Child Care” brochure and on "Reducing the Risk of SIDS and SUID in Early Education and Child Care". LPA provided a Spanish forms packet. Days/Hours of Operation: Monday through Saturday, 5:00 AM to 5:00 PM.


Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies cited.

Exit interview was conducted with licensee. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted to parent’s board and must be posted for 30 days.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2