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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153806122
Report Date: 01/05/2022
Date Signed: 01/05/2022 01:38:04 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:URENA, LUZ FAMILY CHILD CAREFACILITY NUMBER:
153806122
ADMINISTRATOR:URENA, LUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 364-8888
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 5DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Luz Urena TIME COMPLETED:
01:50 PM
NARRATIVE
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On 01/05/2022 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced Required 1-year Inspection and was met by Luz Urena, Licensee. Licensee had 5 children in care. Days and hours of operation are Monday through Sunday but less than 24 hours.

LPAs toured the home inside and outside. Licensee confirmed that the living room, dining room, kitchen, bathroom, bedroom 1, bedroom 2, and fenced back yard was made temporarily inaccessible to day-care children (see 809D). All other rooms are off-limits, by locks and safety knobs. Licensee does have a large sized dog. The dog is kept in the back yard in a gated kennel made inaccessible to day care children. Licensee is aware of child safety around pets and accepts responsibility for any action taken by pets. LPAs advised the importance of supervision at all time. There are no firearms or ammunition on the premises. Poisons are locked in a storage shed in the back yard. Detergents, cleaning compounds are made inaccessible to daycare children.

The fireplace located in living room and is gated not in use during daycare hours. There is a working fire extinguisher. Carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. LPAs discussed the condition of the back yard and play equipment in the current state there are a some potential hazards and clutter LPA made the back yard inaccessible to daycare children. The home has working telephone service and LPAs confirmed the phone number is (661) 364-8888.

Currently Licensee has 2 infants in care. LPAs discussed Safe Sleep Regulations with licensee. 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 was given a log for 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 infant in a separate room. Infants up to 12 months of age are placed on their backs for sleeping. Continue 809C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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 6
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: URENA, LUZ FAMILY CHILD CARE
FACILITY NUMBER: 153806122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during today's inspection counter tops filled with paperwork stacked high, food, dishes, and boxes underneath kitchen nook filled with paper plates, food interfering with walk way in the kitchen. bedrooms with clothing outside of closets, electrical cords hanging from mounted television the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2022
Plan of Correction
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Licensee agrees to clean and organize counter tops, clear walk ways and make bedrooms free of hazards.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review ,Employee rights and Child abuse statement missing from each employee file and copy of drivers license of staff that transport children were not provided at the time of the inspection. The licensee did not comply with the section cited above for 5 assistants, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2022
Plan of Correction
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Licensee agrees to have Licensing forms LIC 508, Employee rights, Drivers licensee for staff that transports children, and Child abuse statement for all assistants submtted by plan of corrrection 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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: URENA, LUZ FAMILY CHILD CARE
FACILITY NUMBER: 153806122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above in 7 out of 15 children's files were missing all required licensing forms and immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2022
Plan of Correction
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Licensee agrees to have each child's authorized representive complete all required licensing forms and submit immunizations by plan of correction 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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: URENA, LUZ FAMILY CHILD CARE
FACILITY NUMBER: 153806122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in back yard had many hazards to children accessible to wood debris, tools, chemicals such as spray cans, fuel, recyclables and clutter, clothing, and a mop on the ground, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2022
Plan of Correction
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Licensee agrees to make the back yard inaccessible until cleaned and made hazard free by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: URENA, LUZ FAMILY CHILD CARE
FACILITY NUMBER: 153806122
VISIT DATE: 01/05/2022
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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. 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 however cross referenced against the roster 7 children’s files were missing. LPA had a discussion with Licensee of updating her roster. Licensee’s Mandated Reporter Training is valid and was previously completed on 06/01/2020 Licensee’s pediatric CPR/First Aid expires on 02/22/2022. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, however missing licensing forms for employees see (809D).

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 deficiencies is being cited: (see next pages, 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6