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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543807642
Report Date: 06/30/2021
Date Signed: 07/01/2021 01:58:02 PM

COMPREHENSIVE INSPECTION
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:RODRIGUEZ, ANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543807642
ADMINISTRATOR:RODRIGUEZ, ANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 739-0192
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 2DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Angelina Rodriguez - Licensee TIME COMPLETED:
05:45 PM
NARRATIVE
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On 6/30/21 Licensing Program Analyst (LPA)Jessika Thompson, conducted an unannounced Required-1 Year Inspection and was met by Licensee Angelina Rodriguez. Also present was assistant, Cristal Rodriguez. Licensee is Spanish Speaking and Cristal Rodriguez assisted with interpretation. Days and hours of operation are Monday through Friday from 5:00AM to 5:30PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch was reviewed and Licensee confirmed that the kitchen, bathroom, day-care room and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locked doors. There was a large accessible concrete dog bowl full of water in the backyard, an accessible fountain full of water also in the backyard, and a large fountain full of water in the front yard. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. LPA observed cleaning compounds in an accessible bathroom cabinet, and accessible pliers, other tools, and cleaning products in the facility backyard.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher and smoke detector. Upon observation, LPA found the facility’s carbon monoxide detector to be inoperable. There was 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) 739-0192.

There were two infants in care. LPA discussed Safe Sleep Regulations with licensee and provided handouts. There is one crib or play yard for each crib 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. The provider did not have a sleep log confirming that she checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing (Continued on LIC809-C).

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

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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 5
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: RODRIGUEZ, ANGELINA FAMILY CHILD CARE
FACILITY NUMBER: 543807642
VISIT DATE: 06/30/2021
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Licensee understands that infants must be visually observed through an open door if sleeping in a separate room. Licensee was unable to provide an Individual Infant Sleeping Plans for Child #1. Licensee places infants on their backs for sleeping.

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. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s was unable to provide proof of Child Abuse Mandated Reporter Training completion. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, 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) 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): 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, LIC809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

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

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: RODRIGUEZ, ANGELINA FAMILY CHILD CARE
FACILITY NUMBER: 543807642
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2021
Section Cited

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Operation of a Family Child Care Home. All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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This requirement was not met, as during today's inspection, in the backyard, LPA observed a large accessible concrete dog bowl full of water, and an accessible fountain full of water. Additionally, a large fountain full of water was observed in the front yard. This poses an immediate health, safety, or personal rights risk to children in care. A civil penalty of $500 was assessed today.
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Type A
06/30/2021
Section Cited

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Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8....The department shall account for the presence of these detectors during inspections.
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This requirement was not met as during today's inspection, LPA found the licensee's carbon monoxide detector to be inoperable. This poses an immediate 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: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: RODRIGUEZ, ANGELINA FAMILY CHILD CARE
FACILITY NUMBER: 543807642
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2021
Section Cited

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Poison, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
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This requirement was not met as evidenced by LPA's observations. During today's inspection, LPA observed (in areas accessible to children) the following items in the bathroom: cleaning products and anti-itch spray. Additionally, in the backyard, LPA observed pliers, a rake, cleaning products, and a pile of wooden scrap planks. This poses an immediate 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: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: RODRIGUEZ, ANGELINA FAMILY CHILD CARE
FACILITY NUMBER: 543807642
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2021
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and
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(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 was not met, as today, Licensee was unable to provide proof of Mandated Reporter Training completion.
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Type B
07/30/2021
Section Cited

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An Individual Infant Sleeping Plan [LIC 9227] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement was not met as during today's visit LPA found Child #1's file to be missing an LIC9227. This poses a potential risk to the health, safety or personal rights of children in care.
Type B
07/30/2021
Section Cited

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The provider shall supervise infants while they are sleeping and adhere to the following requirements:The provider shall physically check on the infant every 15 minutes...This requirement was not met as evidenced by records review. See LIC809 for further details. This poses a potential risk to the health, safety, or personal rights of children in care.
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: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021
LIC809 (FAS) - (06/04)
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