243800117-8-10-2021-04-CC-NLOI-C5RTS2-20210810145824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243800117
Report Date: 08/10/2021
Date Signed: 08/10/2021 02:58:32 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:	CHAVEZ, ELIA FAMILY CHILD CARE		FACILITY NUMBER:	243800117
ADMINISTRATOR:	CHAVEZ, ELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 358-2745
CITY:	ATWATER	STATE: CA	ZIP CODE:	95301
CAPACITY:	12	CENSUS: 4	DATE:	08/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Elia Chavez		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	An unannounced 1- Year Required inspection was conducted today by Licensing Program Analyst, Norma Lomeli. Present during the inspection was Spanish-speaking licensee and four day-care children. Licensee and her adult son are the only persons who resides in the home. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance. The licensee has current pediatric CPR and First Aid was completed through Emergency Medical Services Authority stickers (EMSA) and expires on February 20, 2023. Preventative Health Practice was completed and confirmed at pre-licensing inspection. The home is clean and orderly, with heating and ventilation for safety and comfort. Observed children size furniture and safe toys for the children in care. A current roster of children in care is maintained. Verified that immunizations records are maintained and license updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative. The licensee ensures that children in care are supervised at all times. Fire and disaster drills are conducted at least once every six months and documented with the date and time. Licensee states there are no firearms, ammunition or poisons in the home. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children. There is a fireplace in the living room that is not used during day-care hours. Licensee is advised that fireplace is to be screened when in use to prevent access by children. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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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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: CHAVEZ, ELIA FAMILY CHILD CARE	FACILITY NUMBER: 243800117
	VISIT DATE: 08/10/2021

NARRATIVE

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Facility has a 2A10BC fire extinguisher and smoke detectors that meet State Fire Marshall standards. Facility has a working carbon monoxide detector that meets the statutory requirements.
No bodies of water observed in or on the premises.
Licensee states she maintains licensed capacity at all times.
Licensee is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a).
Incidental Medical Services (IMS) policy was discussed. Licensee stated tha she does provide Incidental Medical Services. 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.

LPA & licensee discussed the Community Care Licensing website: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Hours or operation are Monday through Friday from 7:30 AM to 5:30 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee understands children may not be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found: (See LIC809-D):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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

FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE	FACILITY NUMBER: 243800117
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/27/2021 Section Cited	1 2 3 4 5 6 7	Mandated Reporter Training. On or before March 30, 2018, a person who is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training, shall complete renewal mandated reporter training every two years, the initial mandated reporter training. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Licensee stated that she has not updated her Mandated Reporter Training. This posses a potential risk to the health, safety and/or 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: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

LIC809 (FAS) - (06/04)

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