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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203909760
Report Date: 06/20/2019
Date Signed: 06/20/2019 03:35:25 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:MARAVILLA, MATILDE FAMILY CHILD CAREFACILITY NUMBER:
203909760
ADMINISTRATOR:MARAVILLA, MATILDEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 514-3476
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 9DATE:
06/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Matilde MaravillaTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random inspection and to inspect licensees backyard and 1 bedroom. Licensee wants to use 1 bedroom for napping and make her backyard accessible to children in care. LPA met with Licensee, Matilde Maravilla and assistant and explained the reason of the inspection. A tour of the home was conducted both inside and outside. LPA observed licensee and her assistant caring for 9 children of whom 1 is her own child. licensees 3 minor children were also present during the inspection.

Licensee stated that children currently have access to the living room, dining room area, one bathroom, and part of her side yard. LPA observed the home to be clean and free of toxins. The side yard was observed to have plenty of age appropriate toys, cubbies, books, and small tables and chairs. The backyard has a fence that goes all around. Licensee has put another fence where she stores her gardening tools and other items. The gate has a lock and is inaccessible to children in care.

Licensee has placed plastic door knobs on all her bedrooms to make them inaccessible to children in care. Licensee has also placed a children safety gate at the start of her hallway for extra precaution and another gate at the start of her kitchen to make it inaccessible to children in care. The cleaning supplies are stored underneath the kitchen sink. The knives are stored in a drawer that also has a plastic latch. The garage is inaccessible to children in care. The bathroom was found clean and free of toxins. LPA observed that the bedroom that will be used for napping to be clean and free of toxins. There's a mattress and a drawer that's latched to the wall. Licensee stated that its only going to be used for napping.

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.

Report continued onto LIC 809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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 4
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: MARAVILLA, MATILDE FAMILY CHILD CARE
FACILITY NUMBER: 203909760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
This requirement was not met as evidenced by:
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Licensee stated that she will conduct them and submit a copy to CCL by no later than 06/24/2019
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Licensee failing to conduct fire & Disaster drills within 6 months. Licensee does not have proof that she has conducted any Fire drills with Children. This poses a potential health and safety risk to the children in care.
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Type B
06/24/2019
Section Cited
CCR
102417(g)(7)
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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency...
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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 06/24/2019.
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This requirement was not met as evidenced by Licensee not having the Consent For Emergency Medical Treatment (LIC 627) signed by parents for the 5 children files that were reviewed by LPA. This poses a potential health/safety risk to 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: MARAVILLA, MATILDE FAMILY CHILD CARE
FACILITY NUMBER: 203909760
VISIT DATE: 06/20/2019
NARRATIVE
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Licensee has a 2A10 BC fire extinguisher that was purchased on March of 2019. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 06/09/2020. Licensee does not have proof that she has conducted the fire/emergency drills with children. The carbon monoxide and smoke detector were tested and found in working condition. 4 children's files were reviewed along with the children's roster and LPA noticed that the Consent For Emergency Medical Treatment (LIC 627) was not signed by parents. The Children's roster was completed and up to date. Licensee stated that there are no guns or ammunition in the home and LPA did not observe any bodies of water during the inspection. Licensee and assistant do not have proof that they are both current with the immunization requirements per SB 792. LPA discussed to licensee about the Mandated Reporter Training AB 1207.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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 B deficiency was cited. Appeal rights were explained and provided to Licensee.



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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MARAVILLA, MATILDE FAMILY CHILD CARE
FACILITY NUMBER: 203909760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
HSC
1597.622(a)(1)
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Employees or volunteers at family day care home; immunization requirements; records; exemptions- Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between...
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Licensee sated that she will submit proof of her immunization records to CCL by no later than 06/28/2019.
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This requirement was not met as evidenced by interviewing Licensee/file review and licensee and assistant not having proof that they are up to date with the immunization requirements per SB 792. This poses a potential health/safety risk to 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4