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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243807702
Report Date: 06/12/2019
Date Signed: 06/12/2019 12:17:35 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:ARIAS, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243807702
ADMINISTRATOR:ARIAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 388-1964
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:14CENSUS: 10DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Maria Arias - LicenseeTIME COMPLETED:
12:40 PM
NARRATIVE
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(2) Licensing Program Analyst, Joseph Pacheco, conducted an unannounced Annual/Random inspection today. LPA met with Licensee, Maria Arias, toured the home and backyard, and census was taken. There are no "bodies of water" or firearms in this home. LPA observed two wading pools being stored in the backyard. LPA discussed with Licensee that these types of pools are allowed to be used under constant supervision, but water must be emptied out and wading pool must be put away immediately after use. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is a fireplace in the living room which is off-limits to children in care. Fireplace is made inaccessible to children with a gate. There is a working fire extinguisher, smoke and carbon monoxide detector, and there is adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the backyard play area. Licensee has no pets at this home. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Licensee has a current roster of the children. Fire drills are conducted and documented with the date and time every six months. 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. Pediatric CPR/First Aid are current and expire on 11/4/2019. Licensee is NOT currently providing IMS to children in care.

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



LPA provided licensee with information regarding providing incidental medical services to children, the CDSS Provider Information Notices (PINs) communication system, and some important resources and information links offered on the CDSS website.
CONTINUED ON 809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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: ARIAS, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243807702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2019
Section Cited
CCR
102419(d)(1)
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Admission Procedures and Parental and Authorized Representative’s Rights. The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof
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Licensee to submit copy of LIC 995A - Parents Rights form for Child #1 and Child #3 to Community Care Licensing by 6/21/19.
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that the parent or authorized representative has been notified of his or her rights. This requirement was not met as evidenced by LPA observation of no LIC995A - Parents' Rights Form in the file of Child #1 and Child #3. This item poses a potential risk to the health, safety, or Personal rights of 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: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
LIC809 (FAS) - (06/04)
Page: 3 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: ARIAS, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243807702
VISIT DATE: 06/12/2019
NARRATIVE
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Hours of operation are Monday through Friday, 6:00AM – 6:00PM or as arranged.

An exit interview was conducted with Licensee, Maria Arias.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations the following deficiencies are observed today (SEE 809-D).

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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3