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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243907570
Report Date: 02/04/2020
Date Signed: 02/11/2020 11:39:42 AM

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:MITCHELL, VALERIE FAMILY CHILD CAREFACILITY NUMBER:
243907570
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/04/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Valerie MitchellTIME COMPLETED:
12:00 PM
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On 02/04/2020 Licensing Program Analyst (LPA), Robert Gutierrez, conducted an unannounced Required 1-year inspection and was met by Licensee, Valerie Mitchell also present was assistant Janeth Pascua. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and licensee confirmed that the living room, day care room, dining room, kitchen, hallway bathroom and back yard are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic spinners. There are no swimming pools or other bodies of water on the premises. 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 living room is made inaccessible by a glass screen and will not be in use during daycare hours. The licensee has a 1-A:10-B:C fire extinguisher. There is working smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Licensee has one dog inaccessible to children. The dog is kept in the off-limits dog run located on the side of the house. 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 11/03/2020. Licensees Mandated Reporter Training was completed on 03/24/2018. Ms. Pascua CPR/first aid expires 10/2020. Ms. Pascua Mandated Reporter training was completed on 11/01/2018. 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 was unable to provide LPA with a current roster of the children in care. LPA reviewed a sample of children’s file. LPA observed three children files missing a signed Family Child Care Home Notification of Parent’s rights (LIC 995). 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 Earthquake preparedness checklist, facility license and notification of parent’s rights poster are posted on the living room wall. Emergency disaster plan is in the kitchen near the telephone. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday - Friday, 6:00 am to 6:00 pm.

Continued 809-C

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

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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 4
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: MITCHELL, VALERIE FAMILY CHILD CARE
FACILITY NUMBER: 243907570
VISIT DATE: 02/04/2020
NARRATIVE
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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 Inspection 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: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: MITCHELL, VALERIE FAMILY CHILD CARE
FACILITY NUMBER: 243907570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2020
Section Cited

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Operation of a family child Care home. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by observation conducted during today’s inspection.
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LPA observed a 1-A:10-B:C fire extinguisher. This poses as a potential risk to the health, safety, or personal rights of children in care.
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Type B
02/11/2020
Section Cited

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Operation of a Family Child Care Home. All homes shall have a current roster of the children. This requirement is not met as evidenced by an interview conducted with the licensee.
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Licensee was unable to provide LPA with a current roster of children in care. 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: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: MITCHELL, VALERIE FAMILY CHILD CARE
FACILITY NUMBER: 243907570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2020
Section Cited

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Admission Procedures and Parental and Authorized Representative's Rights
At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06).... This requirement is not met as evidenced by observation and records review conducted during today’s inspection.
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While auditing children files, LPA observed three children files missing a signed LIC995A form. 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: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4