153905262-12-15-2021-04-CC-AGIN-C9QV2R-20211215150334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153905262
Report Date: 12/15/2021
Date Signed: 12/15/2021 03:03:40 PM

Document Has Been Signed on 12/15/2021 03:03 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GILMORE, FATIMAH FAMILY CHILD CARE		FACILITY NUMBER:	153905262
ADMINISTRATOR:	GILMORE, FATIMAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 873-9812
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93305
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	12/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Fatimah Gilmore		TIME COMPLETED:	03:15 PM

NARRATIVE

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On 12/15/21 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced Annual Required Inspection and was met by Licensee, Fatimah Gilmore. Upon LPA’s arrival Licensee was away from the home. Licensee was only twenty minutes away LPA informed Licensee LPA would wait for her. Licensee arrived at 1:00 PM. Days and hours of operation are Monday through Friday 6:00 AM to 12:00 AM.

LPA toured the home inside and outside and a census was taken of 2 children. Licensee confirmed that bathroom, Dining room, Kitchen, Den area is the daycare room, living room, and fenced back yard are used for providing care and are accessible to children. Licensee requested to make Bedroom 3 off limits as the daycare children have access to the bathroom by means of using the living room for access. All other rooms are off-limits and made inaccessible by use of gates and safety knobs and locked doors. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a fireplace located in the living room with a baby gate surrounding it for inaccessibility to children. The fire place is not used during day care hours. . There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPAs confirmed the phone number is (661) 873-9812 and cell (661) 201-4610.

There are currently no infants in care. LPAs discussed Safe Sleep Regulations with licensee. There needs to be 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 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 completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Cont 809C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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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Document Has Been Signed on 12/15/2021 03:03 PM - It Cannot Be Edited

Created By: Araceli Gibson On 12/15/2021 at 02:28 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GILMORE, FATIMAH FAMILY CHILD CARE	FACILITY NUMBER: 153905262
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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 Licensee could not provide proof of immunizations TDAP, MMR or Flu. which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/17/2022
	Plan of Correction
1 2 3 4	Licensee agrees to obtain proof of immunizations, TDAP, MMR, and Flu. and submit copies to CCL by the plan of correction date of 01/17/21.

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:

Susie Fanning

LICENSING EVALUATOR NAME:

Araceli Gibson

LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: GILMORE, FATIMAH FAMILY CHILD CARE	FACILITY NUMBER: 153905262
	VISIT DATE: 12/15/2021

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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 and there are no hazards to children present. 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. Licensee’s Mandated Reporter Training was completed on 08/20/2020. Licensee’s pediatric CPR/First Aid expires on 05/01/2023. Licensee will provide proof of immunization records for the file for influenza, pertussis and measles. (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 ire 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

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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