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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203800070
Report Date: 06/16/2022
Date Signed: 06/16/2022 12:26:31 PM


Document Has Been Signed on 06/16/2022 12:26 PM - 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:BOLANOS' DAY CAREFACILITY NUMBER:
203800070
ADMINISTRATOR:BOLANOS, MERCEDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-3540
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:12CENSUS: 0DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mercedes BolanosTIME COMPLETED:
12:35 PM
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On 6/16/2022 Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez and LPA and Luisa Gavoutian, conducted an unannounced Annual Required Inspection and was met by Licensee, Mercedes Bolanos, and toured the facility indoors and outdoors. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were 0 day care children present. This facility hours and day of operation are from Monday-Saturday from 6:00am to 6:00pm.

Current facility sketch reviewed, and Licensee confirmed that the kitchen, hallway bathroom, backyard, and living room 1, and living room 2 are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of door knob safety cover. During today’s inspection LPAs observed the washing room was accessible. Licensee stated that she will install a child safety gate to the entrance of the washing room, making inaccessible to children. LPAs observed an inflatable wading pool filled with water during inspection. Licensee does not have any children in care or enrolled at this time. LPAs discussed water safety with Licensee, and Licensee understands that wading pools must be filled imminently before use and emptied imminently after use. LPAs directed Licensee to PIN 21-16-CCLD: Seasonal Reminder of Water Safety Requirements and Measures, for additional information.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. LPAs observed the following: cleaning supplies like Clorox wipes, Lysol disinfectant spray; razors, lotions, oils, hand sanitizer, perfumes, Listerine mouth wash, which can be accessible to children in care. The fireplace located in the living room 2 is made inaccessible by a glass door and a child safety latch and will not be in use during daycare hours. There is 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) 232-1382. The outdoor play area in the backyard is fenced and there are no hazards to children. There are outdoor cats and two birds in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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: BOLANOS' DAY CARE
FACILITY NUMBER: 203800070
VISIT DATE: 06/16/2022
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There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has not been completed because there are no enrolled children. Licensee understands that a fire/disaster drill needs to be completed and documented at least once every 6 months. LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 4/19/2022. Licensee’s pediatric CPR/First Aid expires on April 1, 2023. Licensee maintains documentation of immunization's for measles and influenza. Licensee stated that she has received the pertussis vaccine three years ago, but was unable to provide proof of receipt. Licensee stated that she will obtain proof of the vaccine. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. 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



Licensee Mercedes Bolanos 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, 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.

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.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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: 06/16/2022
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LPA discussed the safe sleep regulations with licensee Mercedes Bolanos and discussed the Child Care Licensing Safe Sleep web page athttps://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 infants devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Mercedes Bolanos

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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