153908354-12-1-2021-12-CC-JTHN-C9AU6F-20211201141817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153908354
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:18:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	CARDENAS, AMELIA FAMILY CHILD CARE		FACILITY NUMBER:	153908354
ADMINISTRATOR:	CARDENAS, AMELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 822-1038
CITY:	TEHACHAPI	STATE: CA	ZIP CODE:	93561
CAPACITY:	14	CENSUS: 3	DATE:	12/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Amelia Cardenas		TIME COMPLETED:	02:20 PM

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On 12/01/2021 Licensing Program Analyst (LPA) Jessika Thompson conducted unannounced Annual Required Inspection. LPA was met by Licensee Amelia Cardenas. Also present was Eulalia Cardenas. Licensee is Spanish Speaking therefore Eulalia Cardenas assisted with language interpretation. Days and hours and hours of operation are Monday through Saturday, as needed, less than 24 consecutive hours per child.

LPA toured the home inside and outside and a census was taken. Licensee’s current facility sketch was reviewed, and Licensee confirmed that the kitchen, bathroom, day-care room, bedroom 1 and living room are used for providing care and/or are accessible to children. All other rooms are off-limits and made inaccessible by use of spinning door- knob covers and safety fixtures. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. Licensee did not have an Emergency Disaster Plan on file for review today.

The fireplace located in the living room is made inaccessible by a barricade and will not be in use 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 LPA confirmed the phone number is (661) 822-1038.

LPA discussed Safe Sleep Regulations with licensee. There is 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. Licensee was unable to provide proof that physical assessment documentation is kept on file for infant present today. Licensee was advised that she is required to physically assess 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. (see next page, LIC809-C).

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CARDENAS, AMELIA FAMILY CHILD CARE	FACILITY NUMBER: 153908354
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on facility records review, the licensee did not comply with the section cited above as she did not have an Emergency Disaster Plan available for review during today's inspection. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2021
	Plan of Correction
1 2 3 4	A blank Emergency Disaster Plan was provided to the licensee today. Licensee stated she will complete an Emergency Disaster Plan which is to be kept on file at her facility going forward. Licensee indicated she will submit a copy of the aforementioned plan to the Fresno Community Care Licensing Office by 12/15/21.

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. 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 in three out of three children's files reviewed which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2021
	Plan of Correction
1 2 3 4	A blank PM 286 was provided to the licensee today. Licensee stated she will complete a PM286 for Child #1, Child #2, & Child #3, and submit a copy of the completed records to the Fresno Community Care Licensing Office by 12/15/21. Licensee understands she must complete PM 286 forms for all non-school age children enrolled on an ongoing basis.

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CARDENAS, AMELIA FAMILY CHILD CARE	FACILITY NUMBER: 153908354
	VISIT DATE: 12/01/2021

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Infants can be visually observed through an open door if sleeping in a separate room. No infants under 12 months of age are currently enrolled; however, Licensee was advised that an Individual Infant Sleeping Plan is to be completed and in file for each infant under twelve months of age. Infants are placed on their backs for sleeping.

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 8/16/21. Licensee’s pediatric CPR/First Aid expires on 1/31/23. A review of records indicates that the licensee has immunization records on file for influenza, pertussis and measles.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. (see next page, LIC809C).

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CARDENAS, AMELIA FAMILY CHILD CARE	FACILITY NUMBER: 153908354
	VISIT DATE: 12/01/2021

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If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/process

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, LIC809 D).

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days.

The licensee was provided a copy of her Appeal Rights. An exit interview was conducted and this report was reviewed with Licensee Amelia Cardenas.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

LIC809 (FAS) - (06/04)

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