153909171-11-29-2022-57-CC-NLOI-CLN6QB-20221129200030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153909171
Report Date: 11/29/2022
Date Signed: 11/29/2022 08:25:57 PM

Document Has Been Signed on 11/29/2022 08:25 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MAYEN, SAIDY FAMILY CHILD CARE		FACILITY NUMBER:	153909171
ADMINISTRATOR:	MAYEN, SAIDY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 332-5763
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	14	CENSUS: 5	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Saidy Mayen		TIME COMPLETED:	02:15 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, Norma Lomeli. Present during the inspection was Spanish-speaking licensee and five day-care children. Licensee, her adult son, her adult daughter, her adult brother and one minor child reside in the home. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance or exemption. The licensee completed CPR and First Aid through Pediatric Plus that expires on November 20, 2023. Licensee’s Assistant, Seidy Garcia completed CPR and First Aid through EMS Safety that expires on October 15, 2024. Preventative Health and Safety certification was completed and confirmed at pre-licensing inspection. The home is clean and orderly, with heating and ventilation for safety and comfort. Observed in the living room; children size furniture and safe toys for the day care children. Also observed a diaper changing table, two play yards and a flat screen television on top of a television stand. A current roster of children in care is maintained. Verified that immunizations records are maintained and license updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative. LPA observed several files without immunizations. The 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. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559) 331-0781
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MAYEN, SAIDY FAMILY CHILD CARE	FACILITY NUMBER: 153909171
	VISIT DATE: 11/29/2022

NARRATIVE

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Licensee states there are no firearms, ammunition or poisons in the home.
Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children.
Licensee states there are no firearms, ammunition or poisons in the home.
Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children.
No fireplace in the home.
Facility has a 3A40BC required fire extinguishers and smoke detectors that meet State Fire Marshall standards. Facility has a working carbon monoxide detector that meets the statutory requirements.
No bodies of water observed in or on the premises.
Licensee's and licensee's assistant's Mandated Reporter Training certification is not updated.

Hours or operation are Monday through Friday from 7:30 AM to 6:00 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. Licensee understands children may not be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence.

In exit interview, LPA observed licensee post the Notice of Site Visit and understands it must remain posted for 30 days and retain evaluation report for 3 years.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are cited: (Continued on LIC809-D):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559) 331-0781
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/29/2022 08:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MAYEN, SAIDY FAMILY CHILD CARE	FACILITY NUMBER: 153909171
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(4)(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above. Licensee and Licensee's Assistant, Seidy Garcia did not have proof of Mandated Reporter Training certification, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2022
	Plan of Correction
1 2 3 4	Licensee and licensee's assistant will provide proof of updated Mandated Reporter certification to Fresno Community Care Licensing on or before 12/15/2022.

Type B

Section Cited

CCR

102418(g)

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. 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. Child #1, Child #2 and Child #3 did not have required immunizations on file. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2022
	Plan of Correction
1 2 3 4	Licensee will provide proof to Fresno Community Care Licensing of current immunizations for Child #1, Child #2 and Child #3 on or before 12/15/22.

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	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559) 331-0781
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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