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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908102
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:15:06 PM

Document Has Been Signed on 07/28/2021 12:15 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:JONES, DEBRA FAMILY CHILD CAREFACILITY NUMBER:
153908102
ADMINISTRATOR:JONES, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 805-1205
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Debra JonesTIME COMPLETED:
12:30 PM
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On 7/28/21 Licensing Program Analyst (LPA) Daniel Alvarez conducted an unannounced Required 1-Year Inspection. LPA was met by Licensee Debra Jones. Debra stated she is closed today. Debra stated that last time she had day-care children was about three months ago. Days and hours of operation are Monday through Friday from 5:30AM- 7:30PM and as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the dining room, living room, bedroom #1, and hall bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of child safety spinning plastic door knob covers, locked door(s) and gate(s). There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made accessible.

There are no fireplace or open face heaters in the home. 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 LPA confirmed the phone number is (661) 805-1205.

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. (continued on LIC809-C).

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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 07/28/2021 12:15 PM - It Cannot Be Edited


Created By: Daniel Q Alvarez On 07/28/2021 at 11:12 AM
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: JONES, DEBRA FAMILY CHILD CARE
FACILITY NUMBER: 153908102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal
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Licensee stated she will complete an AB1207 certified Child Abuse Mandated Reporter course by 08/06/21. LPA advised Licensee that this training can be accessed by logging on to the following website: mandated reporter.ca. Licensee indicated that upon completion, she will submit a copy of certification to the Fresno Community Care Licensing (CCL) office, by 08/06/21.
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mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as today, Licensee could not locate her mandated reporter training certificate. This poses a potential risk to the health, safety, or personal rights of children in care.
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Type B
08/06/2021
Section Cited
CCR102417(g)(4)(a)

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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(A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.
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1. Licensee plans to purchase a storage container with a lock to keep poisons in.
2. Licensee will provide proof by 08/06/21.
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This requirement was not met based upon LPA observation of a can of Raid Insect killer(poison) and a bottle of home defense (poison) located throughout the home accessible to day-care children if in care. This poses an immediate Health & Safety risk to children in care if children were in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


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: JONES, DEBRA FAMILY CHILD CARE
FACILITY NUMBER: 153908102
VISIT DATE: 07/28/2021
NARRATIVE
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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 could not located her Mandated Reporter Training Certificate. Licensee’s pediatric CPR/First Aid expired on 07/07/20. Licensee did a course online however it does not meet department regulations. 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 are 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: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/28/2021 12:15 PM - It Cannot Be Edited


Created By: Daniel Q Alvarez On 07/28/2021 at 11:17 AM
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: JONES, DEBRA FAMILY CHILD CARE
FACILITY NUMBER: 153908102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
CCR
102416(c)

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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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1. Licensee will schedule a CPR class within 14 days of the date of this report.
2. Licensee will send a copy of the receipt for CPR to the LPA as soon as she gets the receipt.
3. Licensee will send copy of the CPR and First certificate to the LPA
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The licensee understands CPR certification is a requirement for any individual that will be left alone with children at the family child care home. CPR certification, expiring 06/26/21. CPR and first aid is expired. This poses a potential risk to children in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
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