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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910491
Report Date: 06/02/2021
Date Signed: 06/02/2021 02:41:01 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:TAFOLLA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
163910491
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
06/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Maria TafollaTIME COMPLETED:
02:55 PM
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On 06/02/2021, Licensing Program Analyst (LPA), Ruby Ocegueda conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Tafolla. Licensee is Spanish Speaking. A covid-19 screening was done upon arriving and LPA and licensee wore face coverings during the entire inspection. Days and hours of operation are Monday through Friday 7:30 AM - 5:00 PM or as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch was reviewed and Licensee confirmed that the kitchen, dining room/area, day care room, living room, restroom and 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 know safety covers. There is no swimming pool or other bodies of water on the premises. Licensee stated she has no Firearms or ammunition. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items were observed to be inaccessible today.

The fireplace located in the living room is made inaccessible by a glass cover and will not be in use during daycare hours. There was 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 working telephone service and LPA confirmed the phone number is 559-817-5462 and 559-410-5523.

License cares for one infant. LPA discussed Safe Sleep Regulations with licensee. There is one play yard for the infant and licensee understands that upon enrolling any future infants, she will need a play yard or crib for each one. Cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider stated she physically checks 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 (log observed). Infant sleeps in the living room and can be easily visually observed. Infants up to 12 months of age are placed on their backs for sleeping. Report continued to 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: TAFOLLA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 163910491
VISIT DATE: 06/02/2021
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Individual Infant Sleep Plan (LIC 9227) was reviewed and will be placed in file. LPA reviewed equipment that is allowed in the facility. Car seats are to be used for transportation purposes only and licensee does not provide transportation services at this time. The outdoor play area in the backyard is fenced and there were no hazards to children present at time of inspection. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed that they had emergency information as required. Child #1 was missing proof of MMR immunization. Licensee’s Mandated Reporter Training was completed on 4/23/2021 as did both assistants. Licensee’s pediatric CPR/First Aid expired on 5/18/2021 and licensee is currently in process of enrolling in a Spanish CPR course as in person courses have been limited due to Covid-19. Licensee, Assistant #1 had required immunization's and proof of TB. Assistant #2 had missing proof of required Tdap and MMR immunization's but licensee stated she would be calling the medical provider to provide her a copy. Missing from licensee and both assistant files was LIC 9108 (Statement Acknowledgement to Report Abuse). Assistant files were also missing (LIC 9052) Employee Rights. Licensee to print and place in files. LPA reviewed all forms to be kept in files.

LIS 531 was reviewed with licensee and she stated that a staff #3 received a criminal record clearance by the Department and licensee provided proof via letter from CDSS dated 3/25/2021. Photo of letter taken.

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 deficiencies were cited (see 809-D)

An exit interview was conducted with licensee Maria Tafolla. 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.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
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: TAFOLLA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 163910491
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2021
Section Cited

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Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and
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volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by: staff #2 did not have proof of immunizations (Tdap/MMR). This poses a potential risk to the health, safety, or personal rights of children in care.
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Type B
06/30/2021
Section Cited

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Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. This requirement was not met as evidenced by: Upon children's file review, Child #1 was missing proof of MMR immunization. This is a potential risk to 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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2021
LIC809 (FAS) - (06/04)
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