203800070-9-20-2019-04-CC-JMOA-BG7PJ7-20190920112104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203800070
Report Date: 09/20/2019
Date Signed: 09/20/2019 11:21:10 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:	BOLANOS' DAY CARE		FACILITY NUMBER:	203800070
ADMINISTRATOR:	BOLANOS, MERCEDES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 675-3540
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	12	CENSUS: 0	DATE:	09/20/2019
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Mercedes Bolanos		TIME COMPLETED:	11:30 AM

NARRATIVE

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Licensing Program Manager (LPM) Duane Matsubara, and Licensing Program Analysts (LPAs) Juvenal Moctezuma and Angelica Mejia met with Licensee, Mercedes Bolanos and Daughter Sandra Toscano for an Informal Conference at the Fresno Regional Office. The purpose of the informal conference was to discuss previous deficiencies cited during the Annual/Random inspection that was conducted on August 23, 2019. LPM Matsubara reviewed and discussed the deficiencies with Mercedes Bolanos and daughter Sandra Toscano and how the Family Childcare Home will maintain compliance with the deficiencies cited below. Bolanos Family Childcare has implemented a plan of correction since the deficiencies were cited.

The Department of Social Services, Community Care Licensing Division has determined that Bolanos Family Day Care Home violated licensing regulations pertaining the operation of a Family child Care Home and Criminal Record Clearance:

On 08/23/2019, Licensees adult son, Juan Bolanos was found living in the home prior to obtaining a Criminal Record Clearance.
On 08/23/2019, Operation of a Family Child Care Home: Licensee failed to leave her cleaning supplies like Clorox, Ajax, razors, hydrogen peroxide bottle, beer/liquor bottles, propane gas tanks, sharp gardening tools, amongst other items accessible to children in care.
On 08/23/2019, Operation of a Family Child Care Home: Licensee not having the Consent For Emergency Medical Treatment (LIC 627) signed by parents for the 3 children files that were reviewed by LPA and not having proof that she has conducted Fire Drills within the last 6 months.
On 08/23/2019, Carbon monoxide detectors required; Licensee did not have a Carbon Monoxide in her home.
On 08/23/2019, Employees or volunteers at family day care home; Licensee did not have proof that she was up to date with the immunization requirements per SB 792.

Licensee has submitted proof and corrected all the deficiencies she was cited for except paying her civil penalty for having her adult son reside in her home without having a prior fingerprint clearance.

Report Continued onto LIC 809 C

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: BOLANOS' DAY CARE	FACILITY NUMBER: 203800070
	VISIT DATE: 09/20/2019

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COMPLIANCE PLAN:

In response to these discussions, licensee has agreed to the following.

Licensee will ensure children are provided with safe and healthful environment.
Licensee will have all adults that will live in the home, employees and potential employees who are working or caring for children fingerprint cleared prior to employment.
Licensee will pay the $500.00 civil penalty that was assessed on 08/23/2019.
Licensee will ensure that she has the children's file complete prior to enrollment.
Community Care Licensing will increase frequency of site visits to the facility.
Licensee will watch the Resource Provider Videos and submit in writing what she learned and how she is going to implement what she learned from the video trainings by September 30, 2019.

Licensee shall submit a written plan to Community Care Licensing Division by September 30, 2019 indicating how she will comply with the above requirements. Licensee was informed that training videos are available on the Community Care Licensing website at www.ccld.ca.gov.

Licensee will stay in compliance with CCC Title 22, Division 12 regulations at all times.

Licensee has been advised that failure to maintain compliance with CCR Title 22 Regulations may result in a Non-Compliance Conference (NCC)

This Report was translated in Spanish by LPA Moctezuma.

No Deficiencies Cited during todays Office Visit.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

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