163904938-10-7-2019-04-CC-ROCA-BGQNPH-20191007103821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163904938
Report Date: 10/07/2019
Date Signed: 10/07/2019 10:38:35 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:	RODRIGUEZ, JOSEFA FAMILY CHILD CARE		FACILITY NUMBER:	163904938
ADMINISTRATOR:	RODRIGUEZ, JOSEFA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 584-5148
CITY:	ARMONA	STATE: CA	ZIP CODE:	93202
CAPACITY:	14	CENSUS: 5	DATE:	10/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Josefa Rodriguez		TIME COMPLETED:	10:45 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	Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced annual inspection today. LPA met with Josefa Rodriguez (Spanish Speaking), who provided a tour of the home, inside and outside, as shown on the facility sketch. Licensee had recently submitted new facility sketch to Community Care Licensing (CCL) showing the newly added playroom towards the back of the home. LPA inspected the living room, dining room, kitchen, new daycare room and one restroom attached to the daycare room. Inaccessible rooms were observed to be made inaccessible by way of door spinners. There was no "bodies of water" in this facility. Licensee stated that there are no firearms in this facility. There were no poisons observed and LPA reminded licensee that poisons should be kept locked. Cleaning compounds, medications and other hazardous items were inaccessible to children. There was no fireplace in this facility. The fire extinguishers, smoke detectors, and carbon monoxide indicator were observed to meet CCL regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. This home did not have stairs present. Safe toys and play equipment were observed. There were no pets in this home. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Staff-child ratios were maintained. Outdoor play areas were fenced or supervised by the licensee or care giver. Capacity as specified on the license was being maintained. Children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary. The Licensee and other personnel as specified completed training on preventative health practices including pediatric CPR and first aid; Expires: 8/17/21. Licensee provided proof of required immunization (Pertussis/Measles) for herself and assistants. Written declaration declining flu vaccination was observed today. Licensee provided Certificate of Completion dated: 3/1/18 for required Mandated Reporter Training (AB1207). LPA verified assistants also completed AB1207. Report continued to page 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: RODRIGUEZ, JOSEFA FAMILY CHILD CARE	FACILITY NUMBER: 163904938
	VISIT DATE: 10/07/2019

NARRATIVE

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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.

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.

Business hours are Monday through Friday 6:30 pm to 5:30 pm and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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