543807344-1-11-2023-57-CC-DMEO-CMYQY6-20230111113436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543807344
Report Date: 01/11/2023
Date Signed: 01/11/2023 11:34:50 AM

Document Has Been Signed on 01/11/2023 11:34 AM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	BORUNDA FLORES, ELVA FAMILY CHILD CARE		FACILITY NUMBER:	543807344
ADMINISTRATOR:	BORUNDA FLORES, ELVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 562-6026
CITY:	LINDSAY	STATE: CA	ZIP CODE:	93247
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 1	DATE:	01/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Elva Borunda		TIME COMPLETED:	11:30 AM

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	On 02/18/2021 Licensing Program Analyst (LPA) Diane Mercado, conducted an unannounced Annual Required Inspection and was met by Licensee, Elva Borunda Flores. Also present was staff #1. Licensee is Spanish Speaking and LPA Mercado assisted with interpretation. Days and hours of operation are Monday-Friday 5:30am-5pm. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that living room, dining room, hallway bathroom, kitchen, bedroom #1 (playroom) and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic door spinners and locks. There is no swimming pool or other bodies of water on the premises. 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 living room and is made inaccessible by a glass door 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. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 789-1401. There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. 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 there are no hazards to children present. Capacity as specified on the license is being maintained. Continued 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BORUNDA FLORES, ELVA FAMILY CHILD CARE	FACILITY NUMBER: 543807344
	VISIT DATE: 01/11/2023

NARRATIVE

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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 was completed on 09/19/2022. Licensee’s pediatric CPR/First Aid expires on 08/2024. A review of records indicates that all staff #2 has immunization records on file for influenza, TB, and measles (missing pertussis). Licensee does not have records of immunization for pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Continued 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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

FACILITY NAME: BORUNDA FLORES, ELVA FAMILY CHILD CARE	FACILITY NUMBER: 543807344
	VISIT DATE: 01/11/2023

NARRATIVE

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LPA discussed the 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-and-resources/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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Elva.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/11/2023 11:34 AM - It Cannot Be Edited

Created By: Diane Mercado On 01/11/2023 at 11:24 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BORUNDA FLORES, ELVA FAMILY CHILD CARE	FACILITY NUMBER: 543807344
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Licensee did not have records of immunizations pertussis and measles. Staff #1 is missing pertussis. LPA Mercado informed Licensee immunization records need to be on file for herself and staff which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/10/2023
	Plan of Correction
1 2 3 4	Licensee stated will submit proof to Fresno Regional office of immunizations for her self and staff #1 by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

LICENSING EVALUATOR NAME:

Diane Mercado

LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC809 (FAS) - (06/04)

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