243907570-2-8-2022-04-CC-RGUZ-CBFTBU-20220208133543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243907570
Report Date: 02/08/2022
Date Signed: 02/08/2022 01:35:54 PM

Document Has Been Signed on 02/08/2022 01:35 PM - It Cannot Be Edited

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 CARE		FACILITY NUMBER:	243907570
ADMINISTRATOR:	MITCHELL, VALERIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 710-8537
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	14	CENSUS: 5	DATE:	02/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Valerie Mitchell		TIME COMPLETED:	01:45 PM

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On 02/08/2022 Licensing Program Analyst (LPA) Robert Gutierrez, conducted an unannounced Annual Required Inspection and was met by Licensee, Valerie Mitchell. Also present was Staff #1 (S1). Days and hours of operation are Monday – Friday 7:15 AM – 4:30 PM.

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, restroom and the fenced back yard are used for providing care and are accessible to children. Inspecting the backyard, LPA observed a locked storage shed. All other rooms are off-limits and made inaccessible by use of plastic door knob spinners. LPA inspected kitchen drawers and did not see any hazards inside of them. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are not fenced or barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (209) 710-8537.

There are currently two infants in care. LPA discussed Safe Sleep Regulations with licensee. Licensee understands there needs to be one crib or play yard for each infant in care. Licensee understands cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and no objects should be hanging above or attached to the crib or play yard. Licensee understands infants should not be swaddled while in care. Licensee understands she must physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Licensee stated infants shall sleep in the living room. LPA observed two play yards.

Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: MITCHELL, VALERIE FAMILY CHILD CARE	FACILITY NUMBER: 243907570
	VISIT DATE: 02/08/2022

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Only one play yard contained a tight-fitting sheet (See TV 9102). LPA discussed the Individual Infant Sleeping Plan. Licensee understands the Individual Infant Sleeping Plan must be completed and in file for each infant up to 12 months of age. Licensee understands Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee documents fire drills being conducted once at least every six months. Licensee has a current roster of children in care. Licensee’s Mandated Reporter Training was completed on 04/06/2021. S1 Mandated Reporter Training was completed on 10/02/2021. Licensee’s pediatric CPR/First Aid expires on 11/07/2022. S1 does not have a TB test or immunization records on file. Licensee has record of her immunization records on file for influenza, pertussis and measles.

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.

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 any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, 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 being cited: (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 Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/08/2022 01:35 PM - It Cannot Be Edited

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: 02/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in she did not have a fence installed at the base of the stairs. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/11/2022
	Plan of Correction
1 2 3 4	Licensee stated she shall install a barricade at the base of the stairs. In the meanwhile, Licensee stated children shall play in the fenced day care room and when children need to use the restroom she or S1 shall walk them to this area to prevent them from gaining access to the second floor.

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that S1 did not have a TB test or immunization records on file. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/01/2022
	Plan of Correction
1 2 3 4	Licensee stated she shall have S1 schedule a medical appointment for a TB test and retrieve her immunization records. Once completed all copies shall be submitted to the Fresno Regional Office.

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 Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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