153908500-2-19-2020-04-CC-JTHN-BLXVXU-20200219155008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153908500
Report Date: 02/19/2020
Date Signed: 02/19/2020 03:50:17 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:	LUNA, GRACIE & JAVIER FAMILY CHILD CARE		FACILITY NUMBER:	153908500
ADMINISTRATOR:	LUNA, GRACIE & JAVIER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 746-3455
CITY:	SHAFTER	STATE: CA	ZIP CODE:	93263
CAPACITY:	14	CENSUS: 11	DATE:	02/19/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Gracie & Javier Luna - Licensee		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced Annual/Random Inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA with met with Licensees Javier & Gracie Luna and a census was taken. Also present was Licensees’ assistant Priscilla Delgado. A tour of the facility was made. Background clearances were discussed, and licensee confirmed all adults residing and/or providing care and supervision have a criminal record clearance. Licensees and assistant have current pediatric CPR and First Aid that expires on 01/05/21. Accessible areas of the home are the living room, dining room, kitchen, den, and ground level bathroom. This is a two story home where the stairs are barricaded. The home is clean and orderly, with heating and ventilation for safety and comfort. Safe, healthful, and comfortable toys and day-care related equipment were observed. There is a working telephone. Licensee has three dogs that are inaccessible to children, as they occupy the garage and backyard dog run when children are present. Licensee accepts full liability for any action taken by family pets. A current roster of children in care is maintained. LPA verified that immunization records are maintained, and licensee updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representatives. Licensee ensures that children in care are supervised at all times. Fire and disaster drills are conducted at least once every six months, and documented with the date and time. There are no bodies of water on the premises. There is a firearm that is stored in accordance with Title 22 regulations and inaccessible to children. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored where they are inaccessible to children. Facility has required fire extinguisher and smoke detector, both meet State Fire Marshall standards. Facility has one functioning carbon monoxide detector that meets statutory requirements. Licensee understands children may not be left in parked vehicles. Safe sleep practices for infants was discussed and LPA provided the licensee with a handout. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is subscribed to receive updates via email. Licensee is aware that forms and updated information may be obtained on the Department's website, (www.ccld.ca.gov). Continued on LIC809-C

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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: LUNA, GRACIE & JAVIER FAMILY CHILD CARE	FACILITY NUMBER: 153908500
	VISIT DATE: 02/19/2020

NARRATIVE

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Licensees have proof of Child Abuse Mandated Reporter training, completed 01/20/20. Assistant Priscilla Delgado has proof of Child Abuse Mandated Reporter training, completed 01/22/20. Licensees were advised that this certification must be renewed every two years. Licensees understand that it is their responsibility to stay current with regulations. Licensees were urged to visit the U.S. Consumer Product Safety Commission web page at www.cpsc.gov to ensure that equipment purchased for the day care have not been recalled.

There is a 72 inch unanchored television that is atop a 2.5 foot desk in the den, making it accessible to children. Licensee was advised that this poses a potential risk to children in care, as the size and level of the television presents a tipping hazard.

Incidental Medical Services (IMS) are not currently being provided. Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Licensee was advised that the Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

Hours of operation are Monday through Friday from 5:00 AM to 10:00 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations the following deficiency was observed: (See LIC 809-D)

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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: LUNA, GRACIE & JAVIER FAMILY CHILD CARE	FACILITY NUMBER: 153908500
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/26/2020 Section Cited	1 2 3 4 5 6 7	The home shall be free from defects or conditions which might endanger a child. This requirement was not met, as evidenced by LPA's observations. On 02/19/20, LPA observed an unanchored 72 inch television atop a 2.5 foot desk in the facilty's accessible den.
	8 9 10 11 12 13 14	This poses a potential risk to the health, safety, 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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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