503601761-1-21-2020-04-CC-TMAZ-BL2S22-20200121122848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503601761
Report Date: 01/21/2020
Date Signed: 01/21/2020 12:29:01 PM

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:	BANDY,PAMELA		FACILITY NUMBER:	503601761
ADMINISTRATOR:	BANDY, PAMELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 556-8689
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY:	14	CENSUS: 4	DATE:	01/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Pamela Bandy		TIME COMPLETED:	12:30 PM

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On this date, Licensing Program Analyst (LPA), Theresa Marquez, conducted an unannounced annual inspection and was met by Licensee, Pamela Bandy. Also present was Kristie Anderson, Licensee’s daughter. LPA toured the home inside and outside and a census was taken. Licensee has a working telephone and the above telephone number was verified. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and Notification of Parents Rights poster are posted on day-care room wall.

Current facility sketch reviewed, and Licensee confirmed that the converted garage/playroom, the hall bathroom and the master bedroom which is only used for sleeping children in a play pen only, are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of children’s safety gate. Safe toys and play equipment are observed. There are no stairs in this home. The fireplace located in the living room is made inaccessible and will not be in use during day-care hours. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

There are no firearms or ammunition on the premises. Firearms and ammunition are properly stored in accordance to Title 22 regulations. The outdoor play area in the backyard is fenced and there are no hazards to children present. There are no swimming pools or other bodies of water on the premises. Licensee has four dogs that are inaccessible to children. 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 7/20/2020. Mandated Reported Training was completed on 7/4/2018. An emergency fire/disaster drill has been completed within the last 6 months.

Hours of operation are Monday-Friday, 7:00AM to 5:30 PM.

Continued LIC809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: BANDY,PAMELA	FACILITY NUMBER: 503601761
	VISIT DATE: 01/21/2020

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A review of records indicates that immunization records are in file for children and adults. Licensee has a current roster of the children and maintains emergency information and forms as required. Adequate supervision is being provided during this visit. All adults who reside or work in the home have a criminal record clearance or exemption.

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 deficiency is found (see next page): LIC809-D

A copy of Licensee Appeal Rights was provided to Pamela Bandy today.

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 Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: BANDY,PAMELA	FACILITY NUMBER: 503601761
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/21/2020 Section Cited	1 2 3 4 5 6 7	OPERATION OF A FAMILY CHILD CARE HOME - The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:Poisons, detergents, clean compounds, medicines, firearms which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
	8 9 10 11 12 13 14	This requirement was not met as evidence by observation. LPA observed a bottle of hydrogen peroxide, a bottle of rubbing alcohol & a spray bottle of Lime Away underneath the hall bathroom sink, with no safety lock, accessible to children. This poses a potential risk to the Health, Safety and Personal Rights of children in care.	8 9 10 11 12 13 14
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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 Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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