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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203800070
Report Date: 08/23/2019
Date Signed: 08/23/2019 01:13:23 PM

COMPREHENSIVE INSPECTION
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 CAREFACILITY NUMBER:
203800070
ADMINISTRATOR:BOLANOS, MERCEDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-3540
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:12CENSUS: 1DATE:
08/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mercedes BoalnosTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random inspection and met with Licensee, Mercedes Bolanos. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. LPA observed licensee caring for 1 children who was sleeping on the couch. Licensee stated that 2 other children were at school.

Licensee stated that children have access to the living room, dining room, kitchen area, Family room/playroom, one bathroom, and the backyard. LPA observed that the kitchen/dining room area was cluttered with food items, cans, paperwork, and other items. Licensee stated that she just got a new stove yesterday and was cleaning her kitchen/dining room area. LPA observed a bed in the family room/playroom and observed that there was a fire place that was not covered. Licensee stated that she does not use her fire place and will make sure its covered so its not accessible to children. The living room was observed to be clean and free of toxins.

Licensee was reminded about having Off limit areas closed and locked and the types of toys permitted during her day-care hours. Licensee understood. Licensee stated that the knives are usually stored up high in a pantry next to her medication. The cleaning supplies/toxins are stored in the laundry room. LPA observed 2 bottles of Clorox in the laundry room that were accessible to children in care. Licensee removed them and placed the chemicals and other cleaning products up high. LPA observed bottles of shampoo at the bottom of the tub. LPA advised licensee to not leave her shampoo/conditioner bottles there and to place them up high. LPA observed shaving cream, razors, a bottle of Ajax, a bottle of hydrogen peroxide, amongst other items underneath the bathroom sink. Licensee stated that she will get plastic locks on her cabinets by end of business day today.

The backyard has a fence that goes all around. LPA observed 2 propane gas tanks, gardening tools, and cleaning supplies on the ground where children play. Licensee stated that she is cleaning her backyard and will make sure everything is inaccessible to children. LPA observed a storage room at the corner of the yard with the door open.

Report continued onto LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
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 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2019
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions- 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 volunteer shall receive an influenza vaccination between...
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This requirement was not met as evidenced by interviewing Licensee/file review and licensee not having proof that she is up to date with the immunization requirements per SB 792. This poses a potential health/safety 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2019
Section Cited

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by Licensee failing to
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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. This poses an immediate health/safety risk to children in care.
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than 08/26/2019.
Type A
08/26/2019
Section Cited

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Carbon monoxide detectors required; inspection
Every family day care home for children shall have one or more carbon monoxide detectors in the facility... This requirement was not met as evidenced by
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Licensee stating that she does not have a Carbon Monoxide Detector in her home. This poses an immediate health/safety 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited

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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
This requirement was not met as evidenced by:
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Licensee failing to conduct fire & Disaster drills within 6 months and not having proof for LPA to review. This poses a potential health and safety risk to the children in care.
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Type B
08/30/2019
Section Cited

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency...
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This requirement was not met as evidenced by Licensee not having the Consent For Emergency Medical Treatment (LIC 627) signed by parents for the 3 children files that were reviewed by LPA. This poses a potential health/safety 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2019
Section Cited

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Criminal Record Clearance- All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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This requirement was not met as evidenced by Licensee failing to get her adult son, Juan Bolanos livescanned before residing in her home. This poses an immediate health/safety 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 08/23/2019
NARRATIVE
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LPA observed a mattress, a mini fridge, with a fan. Licensee stated that her son uses it and forgot to lock the door. Licensee stated that the other side of her yard is inaccessible to children since she has gardening tools, chemicals and other items. LPA observed the gate to be open. Licensee stated that she will get a lock and keep it locked at all times. LPA observed beer and liquor stored inside a fridge that's accessible to children in care. Licensee stated that she will remove any beer or liquor bottles from the fridge and store them in areas that are inaccessible to children in care. Licensee understands responsibility of any action taken by pets involving day care children.

LPA spoke about the safe sleep regulations that will take affect this year (2019) with the licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure.

Licensee has a 2A10 BC fire extinguisher that was purchased this year. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 11/09/2020. Licensee stated that she has not conducted fire/disaster drills recently and does not have proof for LPA to review. Licensee does not have a Carbon Monoxide in the home. The smoke alarm was tested and found in working condition. 3 children's files were reviewed and LPA observed that the consent for emergency medical treatment was not signed by parents for all 3 children. LPA observed that the roster was not completed and/or up to date. Licensee stated that there are no guns or ammunition in the home and LPAs did not observe any bodies of water during todays inspection. Licensee does not have proof that she is current with the immunization requirements per SB 792. Mandated Reporter Training AB 1207 was also discussed during todays inspection.

During todays inspection, Licensee stated that her son- Juan Bolanos was present in the home and it currently residing in the home without a prior fingerprint clearance. An immediate civil penalty is assessed of $500.00 for failure to obtain a criminal record clearance for Licensee's adult son who resides in the home.

Report continued onto LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: 08/23/2019
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

During todays inspection, The following type A and Type B Deficiencies were observed. Appeal rights were explained and provided to licensee.

Upon receipt of this report, licensee shall post for 30 days and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

This report was translated in Spanish by LPA Moctezuma.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7