153902695-8-20-2021-04-CC-RMAS-C63R7A-20210820124603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153902695
Report Date: 08/20/2021
Date Signed: 08/20/2021 12:46:10 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:	MENA, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	153902695
ADMINISTRATOR:	MENA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 240-5079
CITY:	WASCO	STATE: CA	ZIP CODE:	93280
CAPACITY:	14	CENSUS: 3	DATE:	08/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Maria Mena		TIME COMPLETED:	01:00 PM

NARRATIVE

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On 08/20/2021 Licensing Program Analyst (LPA), Rene Mancinas, conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Mena, who is Spanish speaking. LPA provided services in Spanish. Days and hours of operation are Monday through Friday 05:00am to 05:00pm.

LPA reviewed current facility sketch and LPA toured the home inside. Licensee confirmed that the living room, dining room, kitchen, children’s restroom, playroom, and backyard are accessible for children to use. All other rooms/areas are off-limits and made inaccessible by use of children safety gate/ child proof devices. There are not pets at this home. There is no swimming pool or other bodies of water on the premises. There is a firearm at this home. Licensee stated there is no ammunition present at the moment. LPA informed that firearms and ammunition need to be locked and stored separately as required per regulations. No poisons were observed during the inspection.

There is a fireplace that is blocked off to be made inaccessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number.

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 located on the side of the house is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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: MENA, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 153902695
	VISIT DATE: 08/20/2021

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LPA discussed Safe Sleep Regulations with licensee. Licensee understands she is to physically check 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. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Pediatric CPR is to expire on 04/17/2023. Child Abuse Mandated Reporter Training was completed on 08/16/2021 and is to be renewed by 08/16/2023. 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 809-D). Appeal rights were provided.

During inspection of the backyard, which is an area accessible to children, LPA observed several items that could potentially pose a threat to the health, safety, and/or personal rights of children in care. LPA observed charcoal bags resting on the play structure, a lawn mower, antifreeze coolant, and other miscellaneous gardening tools. No children were playing in the backyard, and Licensee stated children have not been using the area due to hot weather. LPA informed licensee that such items need to be stored in areas inaccessible to children in care.

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 Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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: MENA, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 153902695
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/30/2021 Section Cited	1 2 3 4 5 6 7	Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced during today's inspection of areas accessible to children in care.
	8 9 10 11 12 13 14	(See 809 for further). This poses a potential risk to the health, safety, and/or personal rights 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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC809 (FAS) - (06/04)

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