543905296-3-6-2020-04-CC-TMAZ-BMFT4L-20200306132406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543905296
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:24:15 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:	PLASCENCIA, ANA FAMILY CHILD CARE		FACILITY NUMBER:	543905296
ADMINISTRATOR:	PLASCENCIA, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 625-0423
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	14	CENSUS: 10	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Ana Plascencia		TIME COMPLETED:	01:45 PM

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On March 6, 2020, Licensing Program Analyst (LPA), Theresa Marquez, conducted an unannounced Required inspection and was met by Licensee, Ana Plascencia. Also present was Assistant Alondra Sanchez. LPA toured the home inside and outside and a census was taken. Licensee has a working telephone and the above telephone number was verified.

Current facility sketch reviewed, and Licensee confirmed that the living room, kitchen/dining area, hall bathroom and the fenced back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of door knob spinners. Safe toys and play equipment were observed. There were no stairs in this home. The fireplace located in the living room was made inaccessible and will not be in use during daycare hours. There was a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

Cleaning compounds, medication and other hazardous items were made inaccessible. There were no firearms or ammunition on the premises. No poisons were observed during inspection.

The outdoor play area in the backyard was fenced and there were no hazards to children present. Swimmin]]g pool was fenced per regulation. The pool gate was self-latching, self-closing and opens away from the swimming pool. No windows or doors had direct access to the pool area. No pets were observed.

Capacity as specified on the license was being maintained. Licensee’s pediatric CPR/First Aid expires on 1/25/2022 . Mandated Reported Training was completed on 1/2019. An emergency fire/disaster drill has been completed within the last 6 months.

A review of records indicates that immunization records were in file for adults. Licensee could not provide immunization records for 2 of the 10 children present today. Licensee has a current roster of the children and maintains emergency information and forms as required. Adequate supervision was being provided during this visit. All adults who reside or work in the home have a criminal record clearance.

Hours of operation are Monday - Saturday, 24 hours a day, with no over 23 hours of continuous care.

Continued LIC809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PLASCENCIA, ANA FAMILY CHILD CARE	FACILITY NUMBER: 543905296
	VISIT DATE: 03/06/2020

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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 these services. .

The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301 (voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, 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 deficiency is found (see next page): LIC809-D

A copy of Licensee Appeal Rights was provided to Ana Plascencia today.

An exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809) and the Notice of Site Visit form (LIC 9213).

The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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: PLASCENCIA, ANA FAMILY CHILD CARE	FACILITY NUMBER: 543905296
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/27/2020 Section Cited	1 2 3 4 5 6 7	IMMUNIZATIONS - The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interview & record review. Licensee could not provide immunization records for 2 of the 10 children present today. This poses a potential risk to the health, safety or personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

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