503608224-4-25-2023-04-CC-JBAA-CR8RJN-20230425130413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503608224
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:04:23 PM

Document Has Been Signed on 04/25/2023 01:04 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GREEN, TABATHA FAMILY CHILD CARE		FACILITY NUMBER:	503608224
ADMINISTRATOR:	GREEN, TABATHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 988-5112
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	14	CENSUS: 6	DATE:	04/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tabatha Green		TIME COMPLETED:	01:15 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 04/25/2023 Licensing Program Analyst (LPA), Julie Baptista, conducted an unannounced Annual Required Inspection and was met by Licensee, Tabatha Green. Also present was Staff #1 assistant/husband(S1). Days and hours of operation are Monday through Friday 7:30 to 5:30. The home has working telephone service and LPA confirmed the phone number is (209) 988-5112. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the day care room, bathroom and side yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of gates and door locks. The outdoor play area in the side yard is fenced and there are no hazards to children present. There is one large dog and one cat. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. 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 day care room. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. During today's inspection, LPA observed that staff have not been documenting the 15 minute sleep check ups for children between the ages of one and two. See 809-D. 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. Continued 809-C

SUPERVISOR'S NAME: Cynthia Brannon	TELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Julie Baptista	TELEPHONE: (559) 767-0213
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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 04/25/2023 01:04 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GREEN, TABATHA FAMILY CHILD CARE	FACILITY NUMBER: 503608224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2023

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 interview and record review, the licensee did not comply with the section cited above in Licensee does not have proof of a current CPR/1st aid which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/16/2023
	Plan of Correction
1 2 3 4	Licensee stated she did have a current pediatric 1st Aid/CPR certificate however could not provide a copy of certification card. LPA observed an old certification card which expired on 7/21/2017. Licensee agrees to send a copy of cedrtification to Community Care Licensing by POC due date.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that staff have not been documenting the 15 minute check ups for children between the ages of one and two which poses a potential health, safety or personal rights risk to persons in care. Licensee stated she thought the requirement was only for children up to 12 months of age. LPA discussed regulations with Licensee and advised her staff needs to be documenting the 15 minute checks for all children up to 24 months old.
	POC Due Date: 05/16/2023
	Plan of Correction
1 2 3 4	Licensee agrees to provide a copy of 15 minute sleep log to Community Care Licensing by POC due date.

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: Cynthia Brannon	TELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Julie Baptista	TELEPHONE: (559) 767-0213
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GREEN, TABATHA FAMILY CHILD CARE	FACILITY NUMBER: 503608224
	VISIT DATE: 04/25/2023

NARRATIVE

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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. 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 6/23/2021. Licensee’s pediatric CPR/First Aid was not available for review. See 809-D. A review of records indicates that all employees and/or volunteers have 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. 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) are not currently being provided. 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)

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.
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.

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

SUPERVISOR'S NAME: Cynthia Brannon	TELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Julie Baptista	TELEPHONE: (559) 767-0213
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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