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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223910603
Report Date: 12/17/2019
Date Signed: 12/17/2019 12:58:28 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 CAREFACILITY NUMBER:
223910603
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
12/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Kendra MunsonTIME COMPLETED:
01:15 PM
NARRATIVE
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On 12/17/2019, at approximately 10:15AM, Licensing Program Analyst (LPA) Candis Rodriguez conducted a case management inspection regarding an incident which occurred at this facility on 11/12/2019.

On 11/12/2019, at approximately 12:10PM, Child #1 entered the hall bathroom, which is accessible to children in care, climbed into the sink and turned on the hot water. Licensee stated she was making lunch in the kitchen and heard crying. Licensee found Child #1 in the sink crying. Licensee immediately turned off the hot water. Licensee noticed blistering on Child #1's right thigh. Licensee attempted to pat dry the area, and let it air dry. Licensee stated she did not use any creams or ointments in an effort not to make the blistering worse. Licensee contacted Child #1's mother immediately and drove Child #1 to a convenient location near the mother's place of work. Licensee stated mother took Child #1 to a hospital to be treated. In an effort to make sure this does not happen again, Licensee turned off the hot water completely from the hall bathroom when she returned. Licensee also turned the hot water heater completely down to it's lowest setting.

On 12/16/2019, at approximately 11:00AM, LPA contacted mother of Child #1. Mother stated Licensee told her immediately about the incident and met her at her work. Mother stated Licensee was obviously upset and sorry about the incident. Mother stated her child is still attending Licensee's day care. Mother stated Child #1 received second degree burns to her thigh but it has healed nicely. Mother stated Child #1 has been doing well since the day of the incident.

On 12/17/2019, at approximately 11:10 AM, LPA attempted to test the temperature of the water in the hall bathroom. The hot water handle was not in use at this time, only the cold water handle. LPA observed the water to be cool and did not warm up at all. Licensee stated a technician was coming today to inspect the hot water heater.
(Continued on LIC 809-C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (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
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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.

Upon receipt, 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 Acknowledgement of Receipt of Licensing Reports (LIC 9224) was given to licensee.

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 JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (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 A
12/18/2019
Section Cited

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Operation of a Family Child Care Home. 102417(g): The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to... This requirement was not met as evidenced by:
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Based on interview with Licensee and Child #1's Mother, Licensee did not ensure the water temperature was kept at a safe temperature to prevent burns. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Licensee agreed to submit proof of receipt to Community Care Licensing after the technician visits the home and inspects the hot water heater.

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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (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)
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