203904637-11-2-2021-04-CC-CBRN-C8DTQF-20211102145551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203904637
Report Date: 11/02/2021
Date Signed: 11/02/2021 02:55:59 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:	MORENO, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	203904637
ADMINISTRATOR:	MORENO, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 352-6258
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	14	CENSUS: 2	DATE:	11/02/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Maria Moreno		TIME COMPLETED:	03:15 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

LPAs Brannon and Iglesias conducted a case management inspection. LPAs met with licensee, Maria Moreno. During today’s inspection, LPAs toured facility, inside and outside, took photographs, conducted interviews with licensee, staff and children, received a copy of current child roster and reviewed child’s file. LPA Iglesias provided interpretation due to licensee is Spanish speaking.

LPA Brannon received an unusual incident report. The incident took place on 10/27/21 at 9:50 PM. The incident involved two minors, child #1 and child #2. Licensee self-reported the unusual incident on 10/28/21, thereby meeting Reporting Requirements for Family Child Care Home (FCCH), Title 22, section 102416.2. Licensee notified City of Madera Police Department on behalf of licensee. A case number has been provided. Licensee has a completed a Suspected Child Abuse Report and will report to CPS.

The incident involved two minors. Licensee provides overnight care. Child #1 and child #2 sleep in bunk beds. Licensee heard a loud thump from the bedroom where the children were located. Upon entering the bedroom, licensee observed that child #1 was not in the lower bunk bed, but up on top with child #2. The children quickly pulled the bed sheets over them. Licensee removed the bed sheets and observed that child #2 was not wearing any clothes and child #1 had on a t-shirt but sweats and underwear were pulled down to the knees. Licensee separated the children. Licensee questioned child #1. Later child #1 revealed that this interaction has been occurring since child #1 was 6 years old. Child #1 turns 8 years old in November.

Interview with licensee revealed that her bedroom door was opened when providing overnight care to day care children. The bedroom door where the children were sleeping was opened. On the night of the incident, licensee was in the master bedroom when she heard the loud thump from the children’s bedroom. The master bedroom is located down the hall and across the hallway. Licensee did not have a monitoring device in the children's bedroom so that the licensee can be assured of hearing a child wake up and provide the required care and supervision to children.

CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

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 3

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: MORENO, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 203904637
	VISIT DATE: 11/02/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During today’s inspection, LPA Brannon provided copies of Title 22, section 102426: Overnight Care and section 102417: Operation of a Family Child Care Home and LIC 9224: Child Care Parent Notification Requirements.

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.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MORENO, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 203904637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/09/2021 Section Cited	1 2 3 4 5 6 7	Overnight Care. If the sleeping arrangements are not situated in such a way that the provider can be assured of hearing a child in care wake up, a digital video and audio monitoring device shall be used. This requirement was not met as evidenced by the inappropriate interaction between two minors that has
	8 9 10 11 12 13 14	Child #1 informed licensee that this happened when he was six years old. Child d#1 will turn eight in November. This occurred while licensee was providing overnight care. This is an immediate personal rights, health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3