503908346-10-2-2023-04-CC-PKVE-CW8QJN-20231002121300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503908346
Report Date: 10/02/2023
Date Signed: 10/02/2023 12:13:08 PM

Document Has Been Signed on 10/02/2023 12:13 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	FERNANDEZ, SYLVIA FAMILY CHILD CARE		FACILITY NUMBER:	503908346
ADMINISTRATOR:	FERNANDEZ, SYLVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 607-0157
CITY:	CERES	STATE: CA	ZIP CODE:	95307
CAPACITY:	14	CENSUS: 8	DATE:	10/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Fernandez, Slyvia		TIME COMPLETED:	12:30 PM

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On 10/02/2023 Licensing Program Analyst (LPA), Pa Kou Vue conducted an unannounced Annual Required Inspection and was met by Licensee Slyvia Fernandez. Also present was Licensee’s assistant. Days and hours of operation are Monday to Friday, 7:30AM-5:30PM.

The home has working telephone service and LPA confirmed the phone number is (209) 607-0157.

LPA toured the home inside and outside and a census was taken and there were 5 children and 3 infants. LPA reviewed current facility sketch (LIC 999A) and Licensee confirmed that the bathroom, living room, kitchen and family roomare used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of a baby gate and doorknob spinners.

There is no swimming pool or other bodies of water on the premises.

Licensee stated, there are no firearms or ammunition on the premises. Licensee stated all poisons are kept in a locked storage area in inaccessible garage. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible and are stored in inaccessible garage.

There is one fireplace in the home located in the family room and is made inaccessible by a screen door and will not be in use during day-care hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

This is a single level home and there are no stairs. Safe toys and play equipment are observed.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

(Continued on 809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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 10/02/2023 12:13 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FERNANDEZ, SYLVIA FAMILY CHILD CARE	FACILITY NUMBER: 503908346
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff records review, Assistant does not have a Mandated Reporter Training AB1207, Immunization Records and LIC508 in file. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/06/2023
	Plan of Correction
1 2 3 4	Licensee will send copies of Assistant's Mandated Reporter Training AB1207, Immunization Records and LIC508 via email to LPA.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on childrens records review, LIC9227's were not in infant's files. Licensee had 3 infants in care. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/06/2023
	Plan of Correction
1 2 3 4	Licensee will send copies of completed and signed LIC9227's via email to LPA.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FERNANDEZ, SYLVIA FAMILY CHILD CARE	FACILITY NUMBER: 503908346
	VISIT DATE: 10/02/2023

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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expires on 10/18/2024. Licensee’s pediatric CPR/First Aid certification expires on 11/2024. A review of records indicates that all employees and/or volunteers does not have immunization records on file for influenza, pertussis, and measles. LPA conducted staff records review and Assistant does not have a Mandated Reporter Training, Immunization Records and LIC508 in file.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed large family childcare home single action door handle requirements per PIN 23-11-CCP.

LPA discussed 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

(Continued on 809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FERNANDEZ, SYLVIA FAMILY CHILD CARE	FACILITY NUMBER: 503908346
	VISIT DATE: 10/02/2023

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Exit interview conducted and report was reviewed with Licensee During the exit interview, the Licensee that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Licensee was provided appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC809 (FAS) - (06/04)

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