163908446-8-8-2019-04-CC-KPAO-BEUMVM-20190808095657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163908446
Report Date: 08/07/2019
Date Signed: 08/08/2019 09:57:09 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:	CABRAL, ROSALBA FAMILY CHILD CARE		FACILITY NUMBER:	163908446
ADMINISTRATOR:	CABRAL, ROSALBA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 707-2591
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 10	DATE:	08/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Rosalba Cabral		TIME COMPLETED:	11:40 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 conducted an unannounced annual/random inspection. LPA met with Licensee, Rosalba Cabral, who provided a tour of the home, inside and outside, as shown on the facility sketch. The swimming pool if fenced per regulation. There are no firearms in this facility. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. The fireplace is inaccessible to children. 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 dog in the home that does not have access to the day care children. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this inspection. The back yard is currently off-limits to day care children. Licensee understands she must contact CCL prior to using her back yard for day care purposes. 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: 11/19. 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. (continued on next page)

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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: CABRAL, ROSALBA FAMILY CHILD CARE	FACILITY NUMBER: 163908446
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/16/2019 Section Cited CCR 102384(a)	1 2 3 4 5 6 7	An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803:. This requirement was not met as evidenced by an outstanding balance of $210.00 on the Licensing Information System (LIS) form CLF551M0. This poses a potential	1 2 3 4 5 6 7	Licensee stated she always pays her fees and does not know how she forgot to pay them this year. She said she will pay the fees immediately.
	8 9 10 11 12 13 14	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: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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: CABRAL, ROSALBA FAMILY CHILD CARE	FACILITY NUMBER: 163908446
	VISIT DATE: 08/07/2019

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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

Business hours are Monday through Friday 5:00 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.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

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