500313336-5-9-2022-04-CC-LGAN-CE9U2T-20220509151229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500313336
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:12:42 PM

Document Has Been Signed on 05/09/2022 03:12 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:	CUSHING, DORENE		FACILITY NUMBER:	500313336
ADMINISTRATOR:	CUSHING, DORENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 632-2768
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	14	CENSUS: 6	DATE:	05/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee - Dorene Cushing		TIME COMPLETED:	03:25 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 05/09/2022, Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA was greeted by Licensee Dorene Cushing who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches provided. Also present was a fingerprint-cleared live-in adult relative and a fingerprint-cleared assistant. Present during today’s inspection were six children. The areas of the home that are accessible to the daycare children are the living room, front room, kitchen, bathroom, two bedrooms, and fenced backyard. “Off-limits” rooms are made inaccessible by locks. No pets were observed during today's inspection. There are no bodies of water in this home. Licensee stated there are no firearms in this home. No poisons were observed during the inspection. LPA observed makeup items such as various tubes of lipstick, eyeshadow, and face powder in an accessible drawer in the bathroom. Licensee removed the items immediately and made them inaccessible. LPA observed two paring knives and two adult scissors in an accessible drawer in the kitchen. Licensee removed the items and made them inaccessible. Fireplace is inaccessible to children by glass door and will not be in use during daycare hours. There is a working fire extinguisher, which was last serviced on 07/20/2021. LPA tested the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment were observed. Adequate supervision is being provided during this inspection, including to napping infants. Upon arrival, LPA observed Child 1 napping in a play yard and was covered with a blanket. Staff 1 removed the blanket immediately. LPA observed the play yard used for Child 2 had a blanket folded and layered on the mattress being used as additional cushioning, a soft toy, and a smaller blanket folded on the mattress being used to rest Child 2's head when napping. Child 2 was not in the play yard.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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 05/09/2022 03:12 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: CUSHING, DORENE	FACILITY NUMBER: 500313336
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

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. 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 that toiletries, knives, and scissors as described in LIC 809 were accessible which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Licensee removed all hazardous items and made them inaccessible. Licensee stated she shall submit a written statement describing how to ensure hazardous items are kept inaccessible in the future.

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. 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 that Child 1 was napping in a play yard with a blanket and Child 2's play yard contained loose articles as described in LIC 809 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Licensee removed the blanket and loose articles from the play yards. Licensee stated she shall submit a written statement describing how to ensure the blankets will be kept out of the play yards in the future.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/09/2022 03:12 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: CUSHING, DORENE	FACILITY NUMBER: 500313336
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 record review, the licensee did not comply with the section cited above in that the mandated reporter training has not been renewed which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/09/2022
	Plan of Correction
1 2 3 4	Licensee stated she shall complete the training and submit a copy of the certificate to CCL by 06/09/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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: CUSHING, DORENE	FACILITY NUMBER: 500313336
	VISIT DATE: 05/09/2022

NARRATIVE

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LPA advised that the items are not allowed in the play yard and Licensee removed all the items from Child 2's play yard. This facility is following appropriate COVID-19 safety guidelines as set forth by the California Department of Public Health for child care providers. Children are supervised when outside in the play area and there are no hazards to children present. Capacity as specified on the license is being maintained. Fire drills are conducted and documented at least once every six months. A current roster of children is maintained.

There is a working telephone and cellphone number was verified. LPA reviewed a sample of children’s files, which were all complete with emergency information as required. Licensee maintains documentation of immunizations for influenza, pertussis, and measles for herself and staff. Licensee’s Pediatric CPR/First Aid are current expiring on 03/13/2023. Licensee’s Mandated Reporter training certificate was completed on 01/22/2020 and must be renewed. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Thursday; 7:30 a.m. – 5:30 p.m.; closed on Fridays.

LPA & Licensee discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms, and Regulations. Licensee stated she is receiving PINs and updates through email. LPA discussed infant items permitted in Family Child Care Homes and left a visual handout. LPA provided Licensee with the “Effects of Lead Exposure” brochure in accordance with AB 2370, Chapter 676, Statutes of 2018.

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 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.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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: CUSHING, DORENE	FACILITY NUMBER: 500313336
	VISIT DATE: 05/09/2022

NARRATIVE

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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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). Exit interview conducted and report was reviewed with the licensee Dorene Cushing.

A notice of site visit was given and must remain posted for 30 days.

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/process.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

LIC809 (FAS) - (06/04)

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