163911116-3-23-2022-04-CC-ROCA-CCSNW9-20220323104911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163911116
Report Date: 03/23/2022
Date Signed: 03/23/2022 10:49:24 AM

Document Has Been Signed on 03/23/2022 10:49 AM - It Cannot Be Edited

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:	MARTINEZ LARA, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	163911116
ADMINISTRATOR:	MARTINEZ LARA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 572-1800
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 7	DATE:	03/23/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Martinez Lara, Maria		TIME COMPLETED:	11:10 AM

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On 3/23/2022, Licensing Program Analyst (LPA) Ocegueda conducted an unannounced case management inspection to address an Unusual Incident that was reported by licensee to the Department on 2/10/2022. LPA Ocegueda informed licensee of the reason for the inspection, toured the facility and took a census.

On 2/10/2022, Licensee contacted the Department to report that child #1 who was in the front living room area stepped on another child’s Bumbo seat, causing child #1 to fall back hitting his/her head on the brick fireplace ledge. The injury included a small cut and some bleeding to the back of the head. Per licensee, first aid was rendered, and authorized representatives were called immediately. There was no other child inside the Bumbo seat at the time of the incident, but the other child in care used the seat throughout the day. LPA interviewed licensee and husband/ assistant separately. Interviews revealed that husband/assistant and licensee were both in the area where child #1 fell (about 8-10 feet away). Licensee had stated husband/licensee was playing with the children in the living area and had moved away briefly to clean up something off the floor when the incident occurred. Child #1 was not taken to obtain medical treatment, but was picked up by the authorized representative and taken home for observation, returning on his/her next scheduled day of care.

Today, LPA inspected file of child #1 and inspected the area and the Bumbo seat that licensee stated child #1 tripped on. The seat was put away today and not in use. LPA also observed that the brick ledge was covered with a thick blanket. There were no tripping hazards observed today in the front living room and licensee was observed continuously picking up toys in the day-care room today. Both areas had been approved for care at the pre licensing inspection. Previous inspection reports do not reveal any guidance on cushioning the ledge area of the fireplace. Licensee stated she was looking for someone to make a custom ledge border to help prevent future injuries and until she obtains something for the ledge, she is avoiding the area for play. LPA recommended licensee create a document where she could communicate any injuries or other important information to parents. LPA also took the time to discuss proper use of all equipment such as weight requirements for equipment and buckles on highchairs. LPA reminded licensee to use all equipment as required by the manufacturer. Report continued on next page 809-C.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

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: MARTINEZ LARA, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 163911116
	VISIT DATE: 03/23/2022

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Today, LPA Ocegueda determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

LIC809 (FAS) - (06/04)

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