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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503807646
Report Date: 11/09/2020
Date Signed: 11/18/2020 03:19:22 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:TAFOYA, FRANCES FAMILY CHILD CAREFACILITY NUMBER:
503807646
ADMINISTRATOR:TAFOYA, FRANCESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 548-9796
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 3DATE:
11/09/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Frances TafoyaTIME COMPLETED:
03:00 PM
NARRATIVE
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On 11/9/20, Licensing Program Analyst (LPA) Diana Martinez conducted a case management tele-inspection to cite a deficiency. LPA spoke with licensee Frances Tafoya and obtained census.

Licensee is to provide safe toys, play equipment, and materials in her home; however, licensee failed to thoroughly inspect all play equipment for choking hazards and a toddler found and choked on a small object that was left behind. Licensee had backside of child within her view so she responded quickly after getting a signal from another child. Licensee administered first aid and subsequently called 911 as item was difficult to dislodge. Paramedics arrived shortly thereafter, and child was transferred to hospital where child was assessed, treated, and released. Child was doing well upon release and did not require further medical treatment.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiency is found and cited on form 809D.

Licensee was provided a copy of appeal rights. Exit interview conducted with licensee Frances Tafoya. Notice of Site Visit Form (LIC 9213) was posted to parents' board and must remain posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Diana D MartinezTELEPHONE: (559) 341-4670
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
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: TAFOYA, FRANCES FAMILY CHILD CARE
FACILITY NUMBER: 503807646
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2020
Section Cited

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Operation of a Family Child Care Home. The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by a choking incident that occurred on 8/31/20, involving a toddler. Toddler had a 1.5 inch plastic piece of a building set lodged in his mouth that hospital personnel removed. Building set is
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recommended for ages 3 and up. This poses a potential risk to the health, safety, or personal rights of children in care.
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website under Health and Safety Information for product recalls to stay current on consumer recalls. Licensee states she will create a daily inspection log to serve as verification of her inspections going forward. Licensee will submit a copy of log to CCLD by 11/16/20. Log should be readily available at any time during inspections.

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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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Diana D MartinezTELEPHONE: (559) 341-4670
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2020
LIC809 (FAS) - (06/04)
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