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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909601
Report Date: 01/22/2020
Date Signed: 01/22/2020 10:41:14 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:QUIROZ, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
243909601
ADMINISTRATOR:QUIROZ, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 394-0033
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY:14CENSUS: 9DATE:
01/22/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Carmen QuirozTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ginny Badhesha conducted an unannounced annual inspection and met with Licensee, Carmen Quiroz. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside as shown on the facility sketches (LIC 999A). Present in the home was the Licensee, Licensee’s daughter (Maytte Hernandez, whom is fingerprint cleared), Licensee’s son (Noe Hernandez, whom is fingerprint cleared) and nine day care children. Upon arrival Licensee’s daughter was home alone with 9 day care children. Fireplace is screened and inaccessible to children in care. Stairs are barricaded when children under age 5 years old are present. LPA observed plenty of age appropriate toys in the day-care room and observed that the house was clean and free of toxins. The knives and medications are stored up high in a cabinet. The chemicals and cleaning supplies are stored in the garage which is always kept locked. The backyard has a fence that goes all around. LPA observed age appropriate toys outside. Two dogs were observed during today’s inspection; licensee understands responsibility of any action taken by pets involving day care children. The last time Licensee conducted the fire/emergency drills with children was on January 6, 2020. Children's files were reviewed and everything was completed and up to date. Children’s roster was missing two children that were present today. Licensee is current with the immunization requirements per SB 792. Licensee has taken the Mandated Reporter Training AB 1207 on January 21, 2020. Licensees CPR/First Aid certificate expires February 2, 2021. LPA spoke about the safe sleep regulations with Licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure. Licensee has a working fire extinguisher, carbon monoxide and smoke detector. There was adequate heating and ventilation for safety and comfort. Licensee stated that she does not have any guns or ammunition in the home and LPA did not observe any bodies of water during the inspection. There is a working telephone and number was verified.

(Continued on 809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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: QUIROZ, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 243909601
VISIT DATE: 01/22/2020
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 any of these services.

Days and hours of operation are Monday through Friday; 5:00am-5:00pm.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, three deficiencies were cited today.

Appeal rights were explained and provided to licensee.

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.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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: QUIROZ, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 243909601
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/22/2020
Section Cited

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Staffing Ratio and Capacity: The capacity specified on the license shall be the maximum number of children for whom care can be provided. If licensee and assistant not present, then the licensee shall comply with the capacity requirements of a Small Family Child Care Home.
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This requirement was not met as evidenced by: Upon LPA's arrival at 8:45am, licensee's daugher/assistant was alone with nine day care children. Licensee was not on the premises due to running an errand. This is an immediate risk to the health, safety and personal rights to 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: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2020
LIC809 (FAS) - (06/04)
Page: 3 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: QUIROZ, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 243909601
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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Mandated Reporter Training: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and 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 was not met as evidenced by file review. During today's inspection, licensee's assistant had an expired Mandated Reporter Training certificate. This poses a potential risk to the health, safety and personal rights of the children in care.
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Type B
01/29/2020
Section Cited

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Children's Roster: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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This requirement was not met as evidenced by LPA review of children's roster. Two children were missing from the most current children's roster. This poses a potential risk to the health, safety and 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: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4