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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543806741
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:13:33 PM


Document Has Been Signed on 04/15/2022 01:13 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:GOVEA, SOCORRO FAMILY CHILD CAREFACILITY NUMBER:
543806741
ADMINISTRATOR:GOVEA, SOCORROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 783-8192
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 4DATE:
04/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Socorro GoveaTIME COMPLETED:
01:45 PM
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On 04/15/2022 Licensing Program Analyst's (LPAs), Ruby Ocegueda and Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensee, Socorro Govea. Also present was Staff #1 and Staff #2 (S1) (S2). Licensee is Spanish Speaking. Days and hours of operation are Monday-Saturday from 6:00 AM – 6:00 PM or other hours as arranged.

LPAs toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room located near the back yard, and one bathroom are used for care. All other rooms are off-limits and made inaccessible by use of baby gates and door knob safety covers. There is no swimming pool or other bodies of water on the premises. Licensee stated that there are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the day care living room is made inaccessible by a permanently placed cubbies and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. LPA inspected toys and equipment inside and outside. The home has working telephone service and LPA confirmed the phone number is 559-783-8192

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and LPA discussed the requirement to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. LPA provided licensee with a blank nap log she could use. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Report continued 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022
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 6


Document Has Been Signed on 04/15/2022 01:13 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: GOVEA, SOCORRO FAMILY CHILD CARE
FACILITY NUMBER: 543806741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on record review, the licensee did not comply with the section cited above. Licensee, assistant #2 and #3 did not have current Mandated Reporter Training. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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Licensee stated she and assistants #2 and #3 would complete the required Mandated Reporter Traiing. LPA reminded licensee of the requirement to complete this training every two years and provided licensee with the appropriate website to complete the training. Proof of completed training will be submitted to the Department by POC date 5/13/2022.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. This poses a potential health, safety or personal rights risk to persons in care. LPA reviewed 4 children's files today and observed two children did not have completed files including emergency information card or consent form. LPA reviewed the requirement. Licensee stated that the children were her grandchildren, however they do not live with her and the parent was not present today. Child #1 comes regularly. This poses potential risk to the health, safety and personal rights of children in care.
POC Due Date: 05/13/2022
Plan of Correction
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LPA discussed the requirement to have completed files with all required licensing forms and documentation with licensee. A list of forms was provided to licensee. Licensee stated she would have completed files with emergency information card and all their licensing forms (Immunization record, LIC 700, LIC 627, LIC 995A, IC 9150) for children #1 and #4, proof will be submitted to the Department by POC date 5/13/2022.

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: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022
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: GOVEA, SOCORRO FAMILY CHILD CARE
FACILITY NUMBER: 543806741
VISIT DATE: 04/15/2022
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and was inspected. Capacity as specified on the license is being maintained.

LPA reviewed children’s files. Licensee was missing 2 out 4 children’s files today. Licensee’s Mandated Reporter Training was completed on 1/20/2020. Licensee indicated she was not aware Mandated Reporter Training was expired for her and S2, S3, had not completed the training. Licensee’s pediatric CPR/First Aid expires on 2/4/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of 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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
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