223910603-12-17-2019-04-CC-CROZ-BJXSP4-20191217130230

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 223910603
Report Date: 12/17/2019
Date Signed: 12/17/2019 01:02:39 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:	MUNSON, KENDRA FAMILY CHILD CARE		FACILITY NUMBER:	223910603
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Kendra Munson		TIME COMPLETED:	01:15 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

Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced annual inspection. LPA was greeted by Licensee Kendra Munson who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Present during today’s inspection were six (6) children. Days and hours of operation are Monday through Friday, 6:00AM to 6:00PM.

Upon entry, LPA observed small children to be barefoot walking and crawling on the floor. The floor in the living room and dining room had food particles, dirt, and toys scattered throughout. LPA observed the kitchen to be “off-limits” to children by a safety gate. LPA observed miscellaneous objects, dishes, clothes, and papers covering counter tops. LPA observed dishes over flowing in the sink. LPA observed Licensee to be cleaning up in the living room and kitchen during this inspection. The floors were swept and counters were organized during this inspection.

The areas of the home that are accessible to the day care children are the living room, dining room, and hall bathroom. “Off-limits” areas are made inaccessible by safety gates or safety door locks. Three (3) dogs were observed outside in a fenced area of the yard. There are no bodies of water on site. No poisons were observed during today’s inspection. There is a fireplace with a glass screen which Licensee stated is not used during day care hours. There is a working fire extinguisher and smoke detector in the home. The home has adequate heating and ventilation. There are no stairs in the home. There are firearms in the home which were observed to be locked according to regulations.

There is a working telephone and number was verified. Capacity as specified on the license is being maintained. Licensee has a current roster of the children, and all required immunizations documentation for children.

(Continued on LIC 809C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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 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: MUNSON, KENDRA FAMILY CHILD CARE	FACILITY NUMBER: 223910603
	VISIT DATE: 12/17/2019

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

Fire drills are conducted and documented with the date and time at least every six months. The last fire drill was completed in October of 2019. Licensee is aware that children are never to be left in parked vehicles.

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. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

Pediatric CPR/First Aid are current expiring in March of 2021. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice.

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 she provides these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). Site Visit Notice posted on the parent board. Exit interview was conducted with Licensee Kendra Munson.

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 FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: MUNSON, KENDRA FAMILY CHILD CARE	FACILITY NUMBER: 223910603
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/03/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home 102417(b): The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's observations, Licensee did not ensure the home was kept clean and orderly while children are in care. This poses a potential risk to the health, safety, and personal rights of 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: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3