203903508-11-15-2023-04-CC-SVGZ-CXLR54-20231115114232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203903508
Report Date: 11/15/2023
Date Signed: 11/15/2023 11:42:40 AM

Document Has Been Signed on 11/15/2023 11:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE		FACILITY NUMBER:	203903508
ADMINISTRATOR:	VILLAGOMEZ, LUZ MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 674-7384
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	14	CENSUS: 3	DATE:	11/15/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Luz Maria Villagomez		TIME COMPLETED:	12:00 PM

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On 11/15/2023 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez, conducted an unannounced Annual Required Inspection and was met by Licensee, Luz Maria Villagomez. LPA explained the reason for the visit and took a census of three children. Also present was Staff #1 and Staff #2. Licensee is Spanish Speaking and LPA Vega-Gonzales assisted with interpretation. Days and hours of operation are Monday through Saturday from 4:00am to 5:00pm.

LPA reviewed facility sketch with Licensee and noted that facility sketch needed to be updated. Licensee will submit updated sketch to the Department. LPA reviewed areas that are accessible to children in care. Licensee confirmed that the Day Care Room, Day Care Room Restroom, and Back Yard are accessible to children. All other rooms are off-limits and made inaccessible by use of a door and lock. LPA did not observe a swimming pool or other bodies of water on the premises, and Licensee stated that here are no swimming pool or other bodies of water. There are no firearms or ammunition on the premises. LPA did not observe any poisons during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. LPA observed two small dogs and one large dogs that are in a fence area in the backyard Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets.

LPA did not observe any fireplaces or open face heaters in the Day Care Room. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. LPA did not observe any stairs in this home. The home has working telephone service and LPA confirmed the phone number is (559) 674-7384.

Continue on LIC809-C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE	FACILITY NUMBER: 203903508
	VISIT DATE: 11/15/2023

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LPA observed infants in care. LPA observed two cribs for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. License stated that infants are not swaddled while in care. Licensee physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. LPA observed during record review that Licensee had an expired Mandated Reporter Training certificate on file. Licensee informed LPA that they did have a current one, yet they did not have a copy on file. Staff #1 has a completed Mandated Reporter Training Certificate that was completed on 6/8/2023. Licensee’s pediatric CPR/First Aid expires on 8/12/2025. Staff #1 pediatric CPR/First Aid expires on 8/12/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Continue on LIC809-C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE	FACILITY NUMBER: 203903508
	VISIT DATE: 11/15/2023

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Licensee Luz Maria Villagomez 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.

LPA discussed the safe sleep regulations with Licensee Luz Maria Villagomez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Luz Maria Villagomez 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 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

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 Luz Maria Villagomez.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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