<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503907838
Report Date: 11/04/2019
Date Signed: 11/04/2019 12:41:47 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:LARA, ELENA FAMILY CHILD CAREFACILITY NUMBER:
503907838
ADMINISTRATOR:LARA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 525-9466
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 3DATE:
11/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elena LaraTIME COMPLETED:
12:00 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
Licensing Program Analyst (LPA) Angelica Mejia conducted an unannounced annual/random inspection and met with Licensee Elena Lara. LPA explained the reason for the inspection, conducted a tour of the home both inside and outside, and a census was taken.

The rooms accessible to children in care are: bathroom, living room, kitchen, and dining room. Off-limits rooms are made inaccessible via plastic door knob spinners and child safety gates. The facility sketch was updated to remove the playroom and backyard from the list of accessible areas at the request of the Licensee. Licensee understands to contact LPA before using any off-limits areas for day care children, as an inspection will be required. Licensee stated she takes the children to the neighborhood park for outdoor play and directly supervises the children at all times while at the park. Licensee stated she has five pets; two large dogs, two small dogs, and one cat. Licensee understands the liability and safety of children around pets and accepts responsibility. Licensee stated her pets are kept inaccessible from children via locked doors and kennels. There are no "bodies of water" on the premises. There are no firearms or ammunition in the home. Poisons are locked in accordance with Title 22 regulations. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is screened and inaccessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment were observed.

There is a working telephone and the number was verified. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee could not locate the children’s files for LPA to review during the inspection. Licensee understands that she is required to maintain a file for each child in care that contains the required licensing documents. Fire/disaster drills are conducted at least every six months, Licensee did not document the last drill conducted. Licensee is aware that children are never to be left in parked vehicles.

(Continued on LIC809-C)

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: LARA, ELENA FAMILY CHILD CARE
FACILITY NUMBER: 503907838
VISIT DATE: 11/04/2019
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
26
27
28
29
30
31
32
All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present in the home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Pediatric CPR/First Aid for Licensee expired 01/20/2019; Licensee agreed to enroll in a CPR/First Aid course within one week. 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. Postings such as Emergency Disaster Plan, Earthquake Preparedness checklist, facility license and notification of parent’s rights poster are posted on entrance wall. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Friday; 08:00 AM – 04:30 PM, and as arranged.

This facility does not provide Incidental Medical Services (IMS). Licensee is aware that an IMS plan is required to be submitted to Community Care Licensing (CCL) if any of these services are provided. LPA discussed IMS with Licensee and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. 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, Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, and Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found:
(see next page: LIC809-D) Licensee was provided a copy of appeal rights.

An exit interview was conducted with Licensee and a copy of this report was provided and discussed.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LARA, ELENA FAMILY CHILD CARE
FACILITY NUMBER: 503907838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2019
Section Cited

1
2
3
4
5
6
7
Personnel Requirements. 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.
8
9
10
11
12
13
14
This requirement was not met as evidenced by LPA observation of a CPR card that expired on 01/20/2019. This poses a potential health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14
Type B
12/04/2019
Section Cited

1
2
3
4
5
6
7
Child's Records. The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requirement was not met as evidenced by interview with Licensee.
8
9
10
11
12
13
14
Licensee could not locate any files for the children in care during the inspection. This poses a potential health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14
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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3