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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243807756
Report Date: 03/02/2020
Date Signed: 03/02/2020 03:11:54 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:GANN, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
243807756
ADMINISTRATOR:GANN, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 826-6508
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:14CENSUS: 7DATE:
03/02/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Angelica GannTIME COMPLETED:
03:30 PM
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On 03/02/2020 Licensing Program Analyst (LPA), Robert Gutierrez, conducted an unannounced required one - year annual inspection and was met by Licensee, Angelica Gann. Staff #1 (S1) later arrived at the facility at approximately 1:20 PM. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room, dining room, kitchen, family room, hallway bathroom and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic door knob spinners and locks. There is a swimming pool that contains a pool cover. S1 walked across the swimming pool cover showing it can support the weight of an adult. The outdoor play area in the backyard is fenced and there are no hazards to children present. There are no firearms or ammunition on the premises. Safe toys and play equipment are observed. Cleaning compounds, medication and other hazardous items are made inaccessible. No poisons were observed during inspection. Stairs are barricaded when children under age 5 years old are present. The fireplace located in the family room is screened and will not be in use during daycare hours. There is working fire extinguisher, smoke detector and adequate heating and ventilation for safety and comfort. Touring inside the facility LPA overheard a carbon monoxide detector beeping several times. LPA read the manufacture instructions located on the back of the alarm and it was determined that the carbon monoxide detector malfunctioned. LPA did not observe a functional carbon monoxide detector. Licensee has one dog that is accessible to children. Licensee understands the liability and safety of children around pets and accepts responsibility. Capacity as specified on the license is being maintained. Licensee’s pediatric CPR/First Aid expires on 09/2020. Licensees Mandated Reporter Training was completed on 02/28/2018. Licensee was unable to locate S1 Mandated Reporter Training. An emergency fire/disaster drill has been completed within the last 6 months. A review of records indicates that immunization records are in file for children and adults. Licensee has a current roster of the children. LPA reviewed a sample of children’s file and observed files were complete. Licensee maintains emergency information and forms as required. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. 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. Postings such as Emergency Disaster Plan, facility license and notification of parents rights poster are posted on the living room and kitchen wall. Days and hours of operation are Monday-Friday, 7:30 am to 5:30 pm.

Continued on 809-C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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: GANN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 243807756
VISIT DATE: 03/02/2020
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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 they provide 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 Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found

(see next page): 809 D

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 is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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: GANN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 243807756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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Carbon monoxide detectors required; inspection Every family day care home for children shall have one or more carbon monoxide detector... This requirement is not met as evidenced by observation
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conducted during today’s inspection. Licensee was utilizing a malfunctioned carbon monoxide detector. This poses as a potential risk to the health, safety, or personal rights of children in care.
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Community Care Licensing (CCL) office by the given due date. In addition, Licensee stated she shall routinely check the carbon monoxide detector to ensure it is properly functioning.
Type B
03/06/2020
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect... shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement is not met as evidenced by records reviewed conducted during today’s inspection. Licensee’s Mandated Reporter training was completed on 02/28/2018. S1 did not have a Mandated Reporter Training certificate on file. This poses as 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3