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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203804609
Report Date: 01/28/2020
Date Signed: 01/28/2020 01:17:40 PM

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:COSIO FAMILY CHILD CAREFACILITY NUMBER:
203804609
ADMINISTRATOR:COSIO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-1453
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 6DATE:
01/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria CosioTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Case Management - Other inspection and met with licensee, Maria Cosio and husband. LPA explained the reason of the inspection and a tour of the home was conducted.

During the Tour, LPA observed a room that is located in the backyard of licensees home. Licensee opened the door and LPA observed a mattress, television, and male clothing. LPA asked whose room that was and licensee stated that adult #1 would occasionally sleep there but has not been home in over a month. Licensee was not able to provide Adults #1's home address and stated that they work out of town but visits licensee frequently and spends the night. LPA explained to licensee that she can not have anyone that is not fingerprint cleared reside in her home. LPA explained to licensee that if she is going to have visitors staying in her home and spending the night, she needs to call licensing or get those adults fingerprint cleared. Licensee understood.

During todays inspection, The following type A Deficiency was 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: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: COSIO FAMILY CHILD CARE
FACILITY NUMBER: 203804609
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2020
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 stating that Adult #1 comes and visits her frequently and spends the night. Adult #1 does not have a fingerprint clearance. 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: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
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