500313259-7-25-2022-04-CC-JPAO-CGNQPM-20220725122057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500313259
Report Date: 07/25/2022
Date Signed: 07/25/2022 12:21:13 PM

Document Has Been Signed on 07/25/2022 12:21 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:	DE ALBA, SANDRA		FACILITY NUMBER:	500313259
ADMINISTRATOR:	DE ALBA, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 544-2013
CITY:	MODESTO	STATE: CA	ZIP CODE:	95357
CAPACITY:	14	CENSUS: 10	DATE:	07/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sandra De Alba - Licensee		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 7/25/22 Licensing Program Analyst (LPA) Joseph Pacheco, conducted an unannounced Annual Required Inspection and was met by Licensee, Sandra De Alba. Also present was Licensee’s Assistant. Days and hours of operation are Monday – Friday, 6:30am – 5:00pm. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed. Licensee confirmed that the kitchen, downstairs bathroom, downstairs bedroom and family room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of door knob spinners or gates. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. LPA observed poisons in an unlocked, inaccessible area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the family room is made inaccessible by a glass door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are 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 with licensee the contact phone number is (209) 544-2013. There is currently one infant in care. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes but has not been documenting these checks. Licensee understands she is to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on CONTINUED ON 812-C

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

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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Document Has Been Signed on 07/25/2022 12:21 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: DE ALBA, SANDRA	FACILITY NUMBER: 500313259
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)(A)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation. LPA observed bug killer next to cleaning supplies in the top shelf of a kitchen cabinet which is inaccessible to children. LPA reminded Licensee that poisons are to be stored in a locked storage container. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Licensee moved the poisons to a locked shed in the backyard during inspection. Deficiency corrected during visit.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation of facility records, LPA observed Licensee's AB 1207 certificate that was completed on 8/1/18 and has not been renewed since. Licensee's assistant did not have a current AB 1207 certificate. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/25/2022
	Plan of Correction
1 2 3 4	Licensee stated she and Assistant will complete the required AB 1207 Mandated Reporter course and provide documentation of current certification to Community Care Licensing by 8/25/22.

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 deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/25/2022 12:21 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: DE ALBA, SANDRA	FACILITY NUMBER: 500313259
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation of facility records and statement from Licensee that her current CPR card was completed on 6/30/20 through an online vendor. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/25/2022
	Plan of Correction
1 2 3 4	Licensee stated she will provide proof of paid registration to an approved CPR vendor to Community Care Licensing by 8/25/22.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation of facility records, Licensee and Assistant received the flu shot during last flu season but did not have documentation of being vaccinated against measles or pertussis. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/25/2022
	Plan of Correction
1 2 3 4	Licensee stated she will provide proof that Assistant and herself have been immunized against measles and pertussis to Community Care Licensing by 8/25/22.

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 deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

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: DE ALBA, SANDRA	FACILITY NUMBER: 500313259
	VISIT DATE: 07/25/2022

NARRATIVE

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the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Per licensee, she ensures that children in care are always supervised 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. 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’s Mandated Reporter Training was completed on 8/1/18. Licensee’s pediatric CPR/First Aid expires on 6/30/22 but was completed through an online vendor. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza. Licensee did not have documentation that she and Assistant have been immunized against pertussis and measles.
All adults who reside or work in the home have a criminal record clearance or exemption. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Per licensee, 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.
CONTINUED ON 812-C

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

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: DE ALBA, SANDRA	FACILITY NUMBER: 500313259
	VISIT DATE: 07/25/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program Website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Licensee, Sandra De Alba.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

LIC809 (FAS) - (06/04)

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