163910611-10-28-2021-04-CC-KPAO-C88NRU-20211028104205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163910611
Report Date: 10/28/2021
Date Signed: 10/28/2021 10:42:11 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:	HOLE, ALICE FAMILY CHILD CARE		FACILITY NUMBER:	163910611
ADMINISTRATOR:	HOLE, ALICE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 816-7787
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 7	DATE:	10/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Alice Hole		TIME COMPLETED:	11:00 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 10/28/2021, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual inspection and met with Licensee Alice Hole. A tour of the home was conducted and a census was taken. Current facility sketch reviewed and Licensee confirmed the day care room and downstairs hall bathroom are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of child safety gates and locked doors. Swimming pool was fenced per regulation with a gate that is self-latching, self-closing, and opens away from the swimming pool. No windows or doors have direct access to the swimming pool area. Firearms and ammunition were properly stored and locked separately. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fireplace is located in the living area that is off-limits to day care children. The fire extinguishers, smoke detectors, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. Stairs barricaded when children under five years of age present. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. The outdoor play area in the backyard is fenced and there are no hazards to day care children. Licensee ensures that children in care are supervised at all times. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children. Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained. Staff-child ratios were maintained. A sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee and all employees and/or volunteers have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee's Mandated Reporter Training was completed on 9/26/2020. Licensee's pediatric CPR and First Aid expires on 1/31/2023. (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: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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: HOLE, ALICE FAMILY CHILD CARE	FACILITY NUMBER: 163910611
	VISIT DATE: 10/28/2021

NARRATIVE

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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

LPA and Licensee discussed an outstanding CCL balance due to Licensee's annual licensing fees having not been paid. LPA and Licensee also discussed CCL's website www.ccld.ca.gov where Licensee could pay the outstanding balance, as well as, have 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.

Business hours are Monday through Friday 5:30 AM to 9:30 PM and other hours as arranged.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Alice Hole.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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: HOLE, ALICE FAMILY CHILD CARE	FACILITY NUMBER: 163910611
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102384(a)

Licensing Fees (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's review of the Licensing Information System Facility Transaction History, the licensee did not comply with the section cited above by not paying the annual licensing fees which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/12/2021
	Plan of Correction
1 2 3 4	Licensee stated she previously attempted to pay her licensing fees, however, her check was mailed back to her. LPA informed Licensee she could pay by mail, check or money order (with her license number attached) or she could pay online at www.ccld.ca.gov using her PIN# (also provided to Licensee). Licensee stated she would pay the outstanding annual and late fees by 11/12/2021.

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: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC809 (FAS) - (06/04)

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