163902876-7-16-2019-04-CC-KPAO-BE5MGQ-20190716093618

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163902876
Report Date: 07/15/2019
Date Signed: 07/16/2019 09:36:24 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:	DAMON, ANDREA FAMILY CHILD CARE		FACILITY NUMBER:	163902876
ADMINISTRATOR:	DAMON, ANDREA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 584-9745
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 7	DATE:	07/15/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Andrea Damon		TIME COMPLETED:	11:30 AM

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	On this date, Licensing Program Analyst (LPA) Kathy Pacheco and LPA Ginny Badhesha conducted an unannounced annual/random inspection. LPAs met with Licensee, Andrea Damon, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this facility. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is in an off-limits room and is not in use. The fire extinguishers, smoke detectors, and carbon monoxide indicator meet Community Care Licensing (CCL) regulations. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. There is one small dog in the home that has access to day care children. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee has a working telephone, however the above listed number has changed to (559) 375-3716. Adequate supervision is being provided during this inspection. Outdoor play areas are fenced or supervised by the Licensee or care giver. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Children’s records contain all emergency information specified by regulation. There are no excluded individuals present at this home. All adults who reside or work in the home have a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary. The Licensee and other personnel as specified have completed training on preventative health practices including pediatric CPR and first aid; Expires: 5/15/20. Licensee provided proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee stated all staff has taken the required Mandated Reporter Training, however, she could not find copies of it. Licensee stated she previously sent the copies to CCL. LPAs advised Licensee if LPAs cannot locate the copies, she will need to provide copies of current required Mandated Reporter Training. (continued on next page)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

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: DAMON, ANDREA FAMILY CHILD CARE	FACILITY NUMBER: 163902876
	VISIT DATE: 07/15/2019

NARRATIVE

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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 Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; information regarding Safe Sleep Regulations; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website.

Business hours are Monday through Friday 6:00 AM to 6:00 PM and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see next page)

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

Any Licensing reports indicating a Type A deficiency shall be posted immediately and for the next 30 days and copies provided of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: DAMON, ANDREA FAMILY CHILD CARE	FACILITY NUMBER: 163902876
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/15/2019 Section Cited CCR 102417(g)(4)	1 2 3 4 5 6 7	Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by LPAs observation of the following items found in kitchen drawers	1 2 3 4 5 6 7	During the inspection by LPAs, Licensee removed the hazardous items and placed them in an inaccessible location to day care children. Citation cleared at today's inspection.
	8 9 10 11 12 13 14	that did not have safety child locks: sharp knife, screw driver, stapler, and stapler remover. This poses an immediate 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
	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: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC809 (FAS) - (06/04)

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