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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543805875
Report Date: 08/21/2019
Date Signed: 08/21/2019 03:13:52 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:FELIZ DAY CAREFACILITY NUMBER:
543805875
ADMINISTRATOR:DELGADO, FELISIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 625-2729
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 7DATE:
08/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Felisiana Delgado - Licensee TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Licensee Felisiana Delgado who provided a tour of the home, as shown on the facility sketch. Licensee is primarily Spanish speaking; therefore, her daughter, Paula Palomino provided translation services. There are no firearms or “bodies of water” on the premises. Off limits areas are made inaccessible by utilization of baby gates and door latches. Required forms are posted. Smoke and carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. Safe toys and play equipment were observed. There is a working telephone. Adequate supervision was provided during this visit. Outdoor play areas are fenced and supervised by the licensee or care giver. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption as indicated on Facility Roster. Licensee has current pediatric CPR and First Aid that expires on 09/01/20. LPA discussed Child Abuse Mandated Reporter training with Licensee. Licensee was advised that when a Spanish version of the training is implemented, she will be required to complete the course every two years. Safe sleep concepts for infants in care were discussed. Licensee maintains proof of immunization, for herself, within the family child care home. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is aware that forms and updated information may be obtained on the CCLD website (www.ccld.ca.gov). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Licensee reported that currently she does not have any children enrolled requiring IMS. Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Business hours are Mon-Fri 7:00 AM to 4:30 PM and as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found (see next page):
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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: FELIZ DAY CARE
FACILITY NUMBER: 543805875
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
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Type B
08/30/2019
Section Cited
CCR
102421(b)
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Operation of a family child care home. An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement was not met as evidenced by records review conducted by LPA. During today's inspection, the licensee was unable to provide an emergency information card, or consent for treatment,
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The licensee will acquire, and maintain proof on site, of the required emergency information for Child #1, Child #2, and Child #3 by 08/30/19.

A return visit is required to clear this deficiency.
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for Child #1, Child #2 & Child #3. This poses a potential risk to the health, safety or personal rights of children in care.

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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 3 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: FELIZ DAY CARE
FACILITY NUMBER: 543805875
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
CCR
102418(a)
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Immunizations. Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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The licensee will acquire, and maintain proof on site, of the required immunization records for Child #1, Child #2, and Child #3 by 08/30/19.

A return visit is required to clear this deficiency.
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This requirement was not met, as evidenced by records review conducted by LPA. During today's inspection, the licensee was unable to provide immunization records for Child #1, Child #2 & Child #3. This poses a potential risk to the health, safety or personal rights of children in care.

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Type B
08/30/2019
Section Cited
CCR
102417(g)(7)
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Child’s Records. The licensee shall maintain, in each child’s record, the signed and dated notice form, Parents Rights Notice (LIC 995A). This requirement was not met as evidenced by
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The licensee will acquire, and maintain proof on site, of the required LIC995As for Child #1, Child #2, and Child #3 by 08/30/19.

A return visit is required to clear this deficiency.
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records review conducted by LPA. During today's inspection, the licensee was unable to provide LIC 995As for Child #1, Child #2 & Child #3. This poses a potential risk to the health, safety or personal rights of children in care.


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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3