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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910107
Report Date: 06/06/2019
Date Signed: 06/11/2019 08:49:18 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:CASEY, LISA FAMILY CHILD CAREFACILITY NUMBER:
163910107
ADMINISTRATOR:CASEY, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 836-4911
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: 18DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Lisa CaseyTIME COMPLETED:
10:20 AM
NARRATIVE
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection. LPA met with Licensee, Lisa Casey. Upon LPA's arrival, LPA observed two assistants and a total of 18 day care children. Licensee stated she knew she was over capacity but it was only for today. She stated there are four children that will no longer be enrolled as of tomorrow. LPA informed Licensee she will need to come into compliance immediately. Licensee contacted parents of four children to advise they needed to be picked up. During LPA's inspection, the children were picked up by parents and Licensee was at a capacity of 14. Licensee provided LPA with a tour of the home, inside and outside, as shown on facility sketch. Swimming pool is fenced per regulation. There are no firearms in this facility. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. The fire extinguishers, smoke detectors, and carbon monoxide indicator meet Community Care Licensing (CCL) regulations. There is a working carbon monoxide detector. 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 are no animals in the home. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this inspection. Outdoor play areas are fenced or supervised by the Licensee or care giver. 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. The Licensee and other personnel as specified have completed training on preventative health practices including pediatric CPR and first aid; Expires: 8/14/20. Licensee also provided proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee also provided proof of required Mandated Reporter Training for all staff. 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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: CASEY, LISA FAMILY CHILD CARE
FACILITY NUMBER: 163910107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2019
Section Cited
CCR
102416.5(a)
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The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by LPA's observation of 18 day care children upon LPA's arrival at the home. This poses an immediate risk to the health, safety, or
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Licensee stated she was only over capacity today because it is four of the children's last day. Licensee called parents of four day care children to pick up the children. During LPA's inspection, the four children were picked up and Licensee was in compliance and at a capacity of 14. Citation cleared today.
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personal rights of children in care.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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: CASEY, LISA FAMILY CHILD CARE
FACILITY NUMBER: 163910107
VISIT DATE: 06/06/2019
NARRATIVE
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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-Friday 6:30 AM to 5:00 PM and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found: (see next page)

Any Licensing reports indicating a Type A deficiency shall be posted immediately and for the next 30 days and copies provided 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. Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
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