153910255-10-17-2019-04-CC-TMAZ-BH2R98-20191017124908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910255
Report Date: 10/17/2019
Date Signed: 10/17/2019 12:49:17 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:	CHACON, ALMA FAMILY CHILD CARE		FACILITY NUMBER:	153910255
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Alma Chacon		TIME COMPLETED:	01:00 PM

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On this date, Licensing Program Analyst (LPA), Theresa Marquez, conducted an unannounced annual inspection and was met by Licensee, Alma Chacon. Also present was Licensee’s adult children Erik Chacon and Enya Chacon. LPA toured the home inside and outside and a census was taken. Licensee has a working telephone and the above telephone number was verified.

Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and Notification of Parents Rights poster are posted on front entrance wall.

Current facility sketch reviewed, and Licensee confirmed that the living room, kitchen, hall bathroom and a bedroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of children’s safety gates and door knob spinners. Safe toys and play equipment are observed. There are no stairs in this home. The fireplace located in the living room is made inaccessible and will not be in use during day-care hours. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

Cleaning compounds, medication and other hazardous items are made inaccessible. There are no firearms or ammunition on the premises. No poisons were observed during inspection.

The outdoor backyard/play area is off limits at this time. There are no swimming pools or other bodies of water on the premises. Licensee has two small dogs that are accessible to children. Licensee understands the liability and safety of children around pets and accepts responsibility.

Capacity as specified on the license is being maintained. Licensee’s pediatric CPR/First Aid expires on 12/2/2019. Mandated Reported Training was completed on 2/24/2018. An emergency fire/disaster drill has been completed within the last 6 months.

(Continued on LIC809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: CHACON, ALMA FAMILY CHILD CARE	FACILITY NUMBER: 153910255
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/01/2019 Section Cited	1 2 3 4 5 6 7	IMMUNIZATIONS - Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by a records review. There is no documented record of Child #1 immunizations on file. This poses a potential Health, Safety and Personal Rights risk to 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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: CHACON, ALMA FAMILY CHILD CARE	FACILITY NUMBER: 153910255
	VISIT DATE: 10/17/2019

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A review of records indicates that immunization records are in file for children and adults. Licensee has a current roster of the children and maintains emergency information and forms as required. All adults who reside or work in the home have a criminal record clearance. There are no excluded individuals present at this home.

Hours of operation are Monday-Friday, 7:00 AM to 5:00 PM.

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 these services.

The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301 (voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, 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 deficiency is found (see next page): LIC809-D

A copy of Licensee Appeal Rights was provided to Alma Chacon today.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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