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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203809838
Report Date: 01/07/2020
Date Signed: 01/07/2020 10:31:35 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:BELTRAN, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
203809838
ADMINISTRATOR:BELTRAN, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-8351
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 3DATE:
01/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Carmen BeltranTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Case Management - Other inspection and met with Licensee, Carmen Beltran and husband. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. LPA observed licensee caring for 3 child whom were all in the playroom watching TV.

Licensee and husband provided proof of immunization records for TB, MMR, and Flu shot but stated that they were still waiting for their appointment to get the TDAP immunization. Licensee provided proof that they have conducted fire drills on 11/29/2019. LPA updated licensees contact information since the phone number CCL had listed was not working. LPA requested a copy of the children's roster but licensee did not have the children's roster up to date and was not able to find the previous one that was showed to LPA during the inspection on 11/26/2019.

During todays inspection, The following type B deficiencies were observed and cited. Appeal rights were explained and provided to Carmen Beltran.

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.

This report was translated in Spanish by LPA Moctezuma.

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: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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 2
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: BELTRAN, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 203809838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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This requirement was not met as evidenced by licensee not having a completed Children's Roster. Licensee was missing the children's home address, DOBs, phone number, parents names, and date enrolled/date left. This poses a potential health safety risk to the 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: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2