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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163903188
Report Date: 11/15/2021
Date Signed: 11/15/2021 03:39:04 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:PULIDO, ALEJANDRA FAMILY CHILD CAREFACILITY NUMBER:
163903188
ADMINISTRATOR:PULIDO, ALEJANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 386-2965
CITY:AVENALSTATE: CAZIP CODE:
93204
CAPACITY:14CENSUS: 1DATE:
11/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Alejandra PulidoTIME COMPLETED:
04:00 PM
NARRATIVE
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On 11/15/2021 Licensing Program Analyst (LPA) Robert Gutierrez, conducted an unannounced Annual Required Inspection and was met by Licensee, Alejandra Pulido. Also present was Adult #1 (A1). Licensee is Spanish Speaking and A1 assisted with interpretation. Days and hours of operation are Monday – Saturday 4:00 AM – 5:00 PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room, dining room, kitchen and hallway bathroom are used for providing care and are accessible to children. Inspecting areas of the home, LPA observed bedroom #3 and #4 doors open. LPA inspected these bedrooms but did not see any items that could pose a danger to children in care. Licensee closed and locked these bedroom doors. Other bedrooms have a plastic door knob spinner to prevent children from entering these bedrooms. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. LPA inspected accessible kitchen drawers/cabinets. LPA observed chemicals such as Clorox, dawn dish soap and several Febreze bottles in a cabinet located underneath the sink. Licensee then located a sliding cabinet lock and placed it on the cabinet handles. Making all items inside inaccessible to children in care.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 386-2965.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. Licensee understands there needs to be one crib or play yard for each infant in care. Licensee understands cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and no objects should be hanging above or attached to the crib or play yard.

Continued on 809-C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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 5
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: PULIDO, ALEJANDRA FAMILY CHILD CARE
FACILITY NUMBER: 163903188
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that Clorox, dawn dish soap and several febreze bottles were accessible to children in care. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2021
Plan of Correction
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Licensee located a sliding cabinet lock and placed it on the handles of the cabinet, making all items inaccessible to children in care.
Cleared during inspection.
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above in that A1 has been living in the facility without a criminal record clearance. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2021
Plan of Correction
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A1 left the facility to get fingerprint associated to the facility.
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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: PULIDO, ALEJANDRA FAMILY CHILD CARE
FACILITY NUMBER: 163903188
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(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
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Based on record review, the licensee did not comply with the section cited above in that she was unable to provide LPA with her Mandated Reporter Certificate. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2021
Plan of Correction
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Licensee stated she shall complete this training and send a copy of the certificate to LPA by the given due date.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Child #1 did not have any paperwork on file. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2021
Plan of Correction
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Licensee stated she shall speak with the legal guardian of Child #1 and have them sign all required paperwork. Once completed licensee shall send copies to LPA by the given due date.
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 FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: PULIDO, ALEJANDRA FAMILY CHILD CARE
FACILITY NUMBER: 163903188
VISIT DATE: 11/15/2021
NARRATIVE
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Licensee understands infants should not be swaddled while in care. Licensee understands she must physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Licensee stated she is not going to care for infants. LPA discussed the Individual Infant Sleeping Plan. Licensee understands the Individual Infant Sleeping Plan must be completed and in file for each infant up to 12 months of age. Licensee understands Infants up to 12 months of age are placed on their backs for sleeping. LPA requested Licensee to contact him once an infant is enrolled into the facility to ensure all regulations are being met.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA was unable to review Children #1 (C1) records. Licensee stated it was C1 first day at the facility and that she did not have any paperwork on file. Licensee documents fire drills being conducted. Licensee has a current roster of children in care. Licensee was unable to provide LPA with her Mandated Reporter Training certificate. Licensee’s pediatric CPR/First Aid expires on 06/28/2022. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

Speaking with A1 he/she stated they recently moved into the facility. A1 does not have a criminal record clearance on file. During inspection A1 left the facility in order to get fingerprint cleared. There are no excluded individuals present at this home.

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 any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Continued on 809-C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PULIDO, ALEJANDRA FAMILY CHILD CARE
FACILITY NUMBER: 163903188
VISIT DATE: 11/15/2021
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies 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. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
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