503905749-8-28-2019-04-CC-TMAZ-BFGQYJ-20190828123513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503905749
Report Date: 08/28/2019
Date Signed: 08/28/2019 12:35:23 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:	COSE, RACHEL FAMILY CHILD CARE		FACILITY NUMBER:	503905749
ADMINISTRATOR:	COSE, RACHEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 522-7599
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	14	CENSUS: 6	DATE:	08/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Rachel Cose		TIME COMPLETED:	12:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Annual inspection and met with Licensee Rachel Cose. Also present was Licensee’s spouse, Russell Cose, and Licensee’s 2 minor children. The working telephone number was verified. Postings such as facility license, Emergency Disaster Plan, Earthquake preparedness checklist, and Notification of Parent’s Rights are posted on dining area wall.

LPA Marquez conducted a tour of the home. A fireplace is inaccessible to children by glass doors and not used during day care hours of operation. A working fire extinguisher is present. The Smoke detector and carbon monoxide indicators were tested and observed to be operational. Stairs are barricaded by a children’s safety gate.

At present the back yard is off-limits to children in care. One dog was observed during today’s inspection; licensee is aware of the safety of children around animals. The dog is kept inaccessible to children via a dog leash and is kept outside. There are no "bodies of water" or firearms in this home.

Capacity as specified on the license is being maintained. Licensee has a current roster of the children. A random sample of Children’s files were reviewed for documentation of immunizations. Staff files were reviewed for record of immunizations; pertussis, measles and influenza for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Right (LIC995A). All adults who reside or work in the home have a criminal record clearance and/or exemption. Pediatric CPR/First Aid is current and expires 4/17/2021. Mandated Reporter training AB 1207 is current and expires 1/16/2020. 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 advance notice.

Days and hours of operation are Monday – Friday; 5:15 AM – 8:30 PM or as arranged.

(Continued on LIC809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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: COSE, RACHEL FAMILY CHILD CARE	FACILITY NUMBER: 503905749
	VISIT DATE: 08/28/2019

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LPA & Licensee discussed the Community Care Licensing (CCL) website, newly proposed Safe Sleep regulations, and the new additions to the website that include the Provider Information Notifications (PIN), including the Quarterly Updates that informs licensees of new legislation and regulations.

LPA discussed Incidental Medical Services (IMS) and provided Licensee with a copy of the Plan for IMS – Family Child Care Home Requirements (FCCH). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for FCCH Section 102417. No IMS are being provided at this time.

A knife was observed in a kitchen drawer accessible to children.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

THE LICENSING FORM LIC9213 NOTICE OF SITE VISIT IS 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: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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: COSE, RACHEL FAMILY CHILD CARE	FACILITY NUMBER: 503905749
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2019 Section Cited	1 2 3 4 5 6 7	OPERATION OF A FAMILY CHILD CARE HOME - Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1.The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
	8 9 10 11 12 13 14	This documentation shall be kept at the family child care home. This requirement was not met as evidenced by observation of record review. Licensee has not conducted a fire drill in the last 6 months. This poses a potential risk to the health, safety and personal rights to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

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