203909186-3-10-2023-04-CC-SVGZ-CPSRXH-20230310122445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203909186
Report Date: 03/10/2023
Date Signed: 03/10/2023 12:24:54 PM

Document Has Been Signed on 03/10/2023 12:24 PM - 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:	CENTENO, ODAIVA FAMILY CHILD CARE		FACILITY NUMBER:	203909186
ADMINISTRATOR:	CENTENO, ODAIVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 439-1268
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	14	CENSUS: 0	DATE:	03/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ODAIVA CENTENO		TIME COMPLETED:	12:35 PM

NARRATIVE

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On 3/10/2023 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez, conducted an unannounced Annual Required Inspection and was met by Licensee, Odaiva Centeno. LPA explained the reason for the visit. Also present were Assistant Alejandra Centeno, Licensee’s husband, and Licensee’s adult son. Licensee is Spanish Speaking and LPA Vega-Gonzalez assisted with interpretation. Days and hours of operation are from Monday to Saturday from 3:00am to 6:00pm.

LPA toured the home inside and outside and a census was taken. Licensee stated that children have access to the first floor of her home- living room, dining room, kitchen area, 1 bathroom, and backyard. Licensee has placed a children's safety gate at the bottom of her stairs to make the upstairs inaccessible to children in care. All other rooms are off-limits and made inaccessible by use of locks and door knob covers. LPA did not observe a swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Licensee stated that all poisons are kept in garage and locked away. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

LPA did not observe any fireplaces or open face heaters in the home. 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 observed that there are stairs in the facility are fenced when children under age 5 years old are present. The home has working telephone service and LPA confirmed the phone number is (408) 439-1268.

Licensee stated she is caring for infants. LPA discussed Safe Sleep Regulations with licensee. LPA observed a play yard for each infant in care, 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.

(Continue on LIC809-D)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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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Document Has Been Signed on 03/10/2023 12:24 PM - It Cannot Be Edited

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: CENTENO, ODAIVA FAMILY CHILD CARE	FACILITY NUMBER: 203909186
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that Upon record review it was observed that Licensee's son Staff #3 had gotten fingerprinted, yet the forms were filled out incorrectly and is not associated to facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2023
	Plan of Correction
1 2 3 4	Licensee stated they made an appointment for her son to get fingerprinted on 3/16/2023. Licensee stated that she will attempt to get her son fingerprinted as soon as possible, and that she will see if he can go to another agency sooner to do so. Licensee stated that she will create an account with Guardian to check individuals associated to her facility or call the Licensing Office if she has any questions regarding fingerprints. Licensee states that this will not happen again.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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: CENTENO, ODAIVA FAMILY CHILD CARE	FACILITY NUMBER: 203909186
	VISIT DATE: 03/10/2023

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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 on 3/10/2023 and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 10/09/2021. Assistant’s Mandated Reporter Training was completed on 09/15/2021. Licensee’s pediatric CPR/First Aid expires on 09/03/2024. Assistant’s pediatric CPR/First Aid expires on 06/05/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

During record review it was observed that Licensee’s adult son had completed a criminal record clearance yet was not associated to facility. LPA obtained a copy of the applicant’s fingerprint response form. All other 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 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. During record review it was observed that IMS is being provided to Child #3. LPA reviewed IMS plan with Licensee.

Licensee Odivia Centeno 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.

(Continue on LIC809-D)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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: CENTENO, ODAIVA FAMILY CHILD CARE	FACILITY NUMBER: 203909186
	VISIT DATE: 03/10/2023

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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 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 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 Odivia Centeno

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC809 (FAS) - (06/04)

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