163906510-12-1-2021-04-CC-RGUZ-C9ARA2-20211201115027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163906510
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:50:36 AM

Document Has Been Signed on 12/01/2021 11:50 AM - It Cannot Be Edited

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:	AYALA, ROSA FAMILY CHILD CARE		FACILITY NUMBER:	163906510
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	12/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rosa Ayala		TIME COMPLETED:	12:15 PM

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On 12/01/2021 Licensing Program Analyst (LPA) Robert Gutierrez, conducted an unannounced Annual Required Inspection and was met by Licensee, Rosa Ayala. Licensee is Spanish Speaking. Days and hours of operation are Monday – Friday 5:00 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, hallway bathroom and the fenced front yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic door knob spinners and door knob locks. LPA inspected kitchen/restroom drawers/cabinets and did not see any hazards inside of them. 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. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

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 a working telephone service and LPA confirmed the phone number is (559) 904-1715.

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. 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 infants shall sleep in the living room. 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.

Continued on 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Robert Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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: AYALA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 163906510
	VISIT DATE: 12/01/2021

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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. The outdoor play area in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee has a current roster of children in care. The last fire drill was conducted on 10/13/2019. Licensee’s Mandated Reporter Training was completed on 07/13/2021. Licensee’s pediatric CPR/First Aid expires on 09/25/2023. A review of records indicates that all employees have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

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.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Robert Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/01/2021 11:50 AM - It Cannot Be Edited

Created By: Robert Gutierrez On 12/01/2021 at 11:21 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: AYALA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 163906510
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that the last fire drill was conducted on 10/13/2019. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2021
	Plan of Correction
1 2 3 4	Licensee stated she shall send documentation of a conducted fire drill to the Community Care Licensing (CCL) office. Proof of this correction shall be sent by the given due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

LICENSING EVALUATOR NAME:

Robert Gutierrez

LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

LIC809 (FAS) - (06/04)

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