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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203902432
Report Date: 08/09/2019
Date Signed: 08/09/2019 03:33:10 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:MUNOZ, YOLANDA FAMILY CHILD CAREFACILITY NUMBER:
203902432
ADMINISTRATOR:MUNOZ, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 661-2180
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 9DATE:
08/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Yolanda MunozTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Juvenal Moctezuma and Diane Mercado conducted an unannounced Annual/Random inspection and met with Licensee, Yolanda Munoz. LPAs explained the reason of the inspection and a tour of the home was conducted both inside and outside. Licensee stated that she was currently caring for a total of 9 day-care children including her grandchild. LPAs observed that child #1 was sitting in a high chair eating, Child #2 was laying awake in a white crib, child #3 was inside a play pen, child #4 was laying in a crib, while the other children were playing in the living/dining room.

LPAs notified licensee that she was out of ratio and she would need to call her assistant. Licensee stated that she could not get a hold of her assistant so she started to call parents to pick up children.

Licensee stated that children have access to the living/dining room, one bathroom, and backyard. Licensee has placed children's safety gates so children don't have access to the Kitchen area. Licensee stated that children don't have access to the rooms. Upon arrival, LPAs observed that the two bedrooms were accessible to children in care since the doors were open.

LPA observed plenty of age appropriate toys in the living room and observed that the home was cluttered with paperwork and boxes. LPAs observed that the first bedroom was full of clothing and LPAs could not walk inside. Licensee closed the second room and was not able to find the key so LPA was not able to inspect that room. The bathroom contained a changing table and licensee put a plastic latch so children don't have access to the items underneath the bathroom sink.

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: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
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 6
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: MUNOZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 203902432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
CCR
102417(b)
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Operation of a Family Child Care Home. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not meet as evidenced by LPA's observation of dishes in the sink, leftover food on the kitchen counters, the play area was cluttered with paperwork and boxes. Food on the kitchen, living room and dining room floors. During today's inspection, LPA observed three infants walking and crawling on the
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Licensee stated that she will clean and keep her home organized at all time while children are present. licensee will write a plan of correction stating how this will not happen again and submit a written copy to CCL
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floors. LPA observed toys were cluttered in the living/dining room area. This is a potential health, safety and personal rights risk to children in care.
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by no later than 08/23/2019.
Type B
08/23/2019
Section Cited
CCR
1596.841
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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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Licensee stated that she will complete her children's roster and submit a copy to CCL by no later than 08/23/2019.
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This requirement was not met as evidenced by licensee not having a completed Children's Roster. The roster did not include 6 of the children that were in care. 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: 08/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MUNOZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 203902432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2019
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. This requirement was not met as evidenced by LPAs observations. Upon arrival, LPAs observed that the licensee was carinf for 9 children without an assistant.
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Licensee will write a plan of correction stating how this will not happen again and submit a written copy to CCL by no later than 08/12/2019.
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This poses an immediate risk to the health, safety, or personal rights of children in care.
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Type A
08/12/2019
Section Cited
HSC
1597.44(b)
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No more than two infants are cared for during any time when more than six children are cared for. This requirement was not met as evidenced by LPAs file review and licensee stating that she was carign for a total of 4 infants and 5 children betwwen the ages of 2-5 years of age.
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Licensee will write a plan of correction stating how this will not happen again and submit a written copy to CCL by no later than 08/12/2019.
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This poses an immediate risk to the health, safety, or personal rights of 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: 08/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: MUNOZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 203902432
VISIT DATE: 08/09/2019
NARRATIVE
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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: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: MUNOZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 203902432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2019
Section Cited
CCR
102417(g)(4)
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Poisons/Detergents/Cleaning Supplies/Medicines/Firearms. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
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Licensee will write a plan of correction stating how this will not happen again and submit a written copy to CCL by no later than 08/12/2019.
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Based on observation, licensee failed to make the medication and syringe needles which are hazardous items inaccessible to children in care. This is a immediate risk to the health, safety, or personal rights of 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: 08/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MUNOZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 203902432
VISIT DATE: 08/09/2019
NARRATIVE
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LPAs observed a bag of creams with a box of Tiaminal B12 (syringe needles). The kitchen counter was full of dishes, bags, leftover food items, and a oral syringe with medicine that licensee stated that she was going to provide that to Child #5. The backyard has a fence that goes all around. Licensee stated that she has not used it due to the hot weather.

Licensee has a 2A10 BC fire extinguisher that was last serviced on 02/01/2017. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 05/25/2021. LPA spoke about the safe sleep regulations that will take affect this year (2019) with 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.

The carbon monoxide and smoke detector were tested and found in working condition. 7 children's files were reviewed and everything was completed and up to date. Licensee's children's roster was incomplete and was missing 6 of the children that were present during todays inspection. 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 has proof that she is up to date with the immunization requirements per SB 792. Mandated Reporter Training AB 1207 was discussed during todays inspection. After concluding the inspection, Licensee was left with 4 children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
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