163909944-7-14-2021-04-CC-KPAO-C4WRTJ-20210714131826

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163909944
Report Date: 07/14/2021
Date Signed: 07/14/2021 01:18:32 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:	MORALES, GRACIELA FAMILY CHILD CARE		FACILITY NUMBER:	163909944
ADMINISTRATOR:	MORALES, GRACIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 582-8608
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 9	DATE:	07/14/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Graciela Morales		TIME COMPLETED:	01:30 PM

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 7/14/2021, Licensing Program Analyst (LPA) Kathy Pacheco and LPA Araceli Gibson conducted an unannounced case management inspection. LPAs met with Licensee, Graciela Morales, to discuss an incident that occurred on 4/7/2021. A complete file review was conducted prior to the inspection. LPAs took a census, interviewed Licensee, and observed area in which the incident occurred. On the date of the incident, child #1 (see Confidential Names form (LIC 811) dated 7/14/2021) was in the kitchen/family room area near the edge of the carpet leading to the tile floor in the kitchen. Child #1 was 10 months old and was learning to walk. There was a small child chair in the family room area on the carpet, near the edge of the tile floor leading to the kitchen. Child #1 attempted to pull herself up on the back of the small child chair. Licensee was in the kitchen doing the dishes. Licensee stated child #1 had socks on at the time and she was not sure if the socks caused child #1 to slip while she was holding on to the back of the small child chair. Licensee said as child #1 was holding on to the back of the small child chair and attempting to pull herself up, she fell backwards from the carpet area on to the tile floor. Licensee said child #1 was still holding on to the small child chair when she fell and the small child chair fell on top of her. Licensee said child #1 began crying and she went to her immediately. Licensee said she made sure child #1 was okay and then she contacted child #1's mother. Licensee said child #1's mother was already on her way to pick up child #1 and arrived within five minutes. Licensee said prior to the mother arriving, she noticed a small bump on the side of child #1's head and she placed ice on it. Licensee said child #1's mother took child #1 to the emergency room, but it was too busy, and they eventually left. Licensee said she contacted child #1's mother that night to make sure child #1 was doing okay and her mother said she was. Licensee said child #1 returned to the day care the next day and was okay. Licensee said the bump on child #1's head went away within a few days. Licensee said there have not been any other incidents since that time. (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: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: MORALES, GRACIELA FAMILY CHILD CARE	FACILITY NUMBER: 163909944
	VISIT DATE: 07/14/2021

NARRATIVE

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Based on the information obtained, LPAs determined Licensee handled the incident correctly and reporting requirements were met. After interviewing Licensee, LPAs determined Licensee took appropriate measures to address child #1's injury. LPAs further determined Licensee followed proper policies and procedures and no regulations were violated.

LPAs also discussed Safe Sleep Regulations with Licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping. There are no objects hanging above or attached to the crib or play yard. Infants in care are not swaddled. Licensee physically checks on sleeping infants every 15 minutes and documents any signs of distress, to include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.

Exit interview conducted with Licensee. A copy of the Facility Evaluation Report (LIC 809) and the Notice of Site Visit (LIC 9213) were provided to the facility. LIC 809 is required to remain in the facility for public review and the LIC 9213 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: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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