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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909735
Report Date: 06/11/2019
Date Signed: 06/11/2019 10:53:37 AM

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:PENA, ROBBIN FAMILY CHILD CAREFACILITY NUMBER:
153909735
ADMINISTRATOR:PENA, ROBBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 746-2841
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:14CENSUS: 6DATE:
06/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Robbin PenaTIME COMPLETED:
11:00 AM
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An unannounced annual/random inspection conducted by Licensing Program Analyst (LPA) Gloria Reyes. LPA met with Licensee, Robbin Pena. The individuals who reside in the home is licensee, licensee's spouse, two adult children and two grandchildren. LPA toured the facility inside and outside. The licensee cares for children in the living room, front room, dining room, play room and bathroom. There is a three tier fountain in the front yard. The first tier has river rocks in place. No bodies of water on site. No firearms or ammunition are in the home. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children. Poisons are locked. Fireplaces and open face heaters are screened to prevent access by children. Fire extinguisher, smoke detector, carbon monoxide detector are operable and in place. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in this home. The home provides safe toys, play equipment, and materials. The licensee is present in the home and ensures that children in care are supervised at all times. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her absence. The licensee maintains capacity specified on the license. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children and a copy is secured. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. There are no excluded individuals in the home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to home or having contact with children in care. (see next page)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 06/11/2019
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All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. The licensee and other personnel as specified have completed training on preventive health practices including pediatric CPR and pediatric First Aid which expires 12/20/19. LPA verified that required the Mandated Reporter Child Abuse (AB 1207) training has been completed by licensee. Licensee has two indoor cats that are accessible to day care children. Licensee accepts responsibility of any action taken by pets.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA provided information on Safe Sleep guidelines to the licensee. The practice of safe sleep for infants in care was reviewed. LPA provided Licensee with handouts on "Safe Sleep Regulations Concepts", "Individual Infant Sleeping Plan", “Safe Sleep in Child Care” brochure and on "Reducing the Risk of SIDS and SUID in Early Education and Child Care". Licensee was provided a copy of the “Lead Poisoning Facts” brochure. Licensee to refer to PIN 19-04-CCP, for further information.
Days/Hours of operation: Monday through Friday, 6:30 AM to 5:30 PM.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies cited during today's visit.

Exit interview was conducted with licensee. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted to parent’s board and must be posted for 30 days.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
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