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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543905345
Report Date: 02/05/2020
Date Signed: 02/06/2020 08:58:00 AM

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:RENTERIA, DORA FAMILY CHILD CAREFACILITY NUMBER:
543905345
ADMINISTRATOR:RENTERIA, DORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 687-9776
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:14CENSUS: 9DATE:
02/05/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Dora RenteriaTIME COMPLETED:
02:20 PM
NARRATIVE
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On 2/5/2020, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection. LPA met with Licensee, Dora Renteria, who provided a tour of the home, inside and outside, as shown on the facility sketch. The swimming pool is fenced per regulation. There were no firearms in this facility. Poisons, cleaning compounds, medications and other hazardous items were inaccessible to children. Fireplace was not in use and not used during day care hours. The fire extinguishers, smoke detectors, and carbon monoxide indicator met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. Stairs were barricaded with children under five years present. Safe toys and play equipment were observed. There was one small animal in the home. Licensee understood the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Outdoor play areas were fenced or supervised by the Licensee or care giver. Capacity as specified on the license was being maintained. Staff-child ratios were maintained with an assistant present. Children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary. The Licensee and other personnel as specified completed training on preventative health practices including pediatric CPR and first aid; Expires: 7/14/2020.

LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; information regarding Safe Sleep Regulations; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website.
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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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: RENTERIA, DORA FAMILY CHILD CARE
FACILITY NUMBER: 543905345
VISIT DATE: 02/05/2020
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Licensee is aware that an IMS plan is required to be submitted to the Licensing office if they provide any of these services.

Business hours are Monday through Friday 6:00 AM to 6:00 PM and other hours as arranged.

Per Title 22 of the California Code of Regulations, the following deficiency was observed: (see next page)

Exit interview was conducted with Licensee. LPA provided copies of the report, appeal rights, and Notice of Site Visit form to Licensee.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
LIC809 (FAS) - (06/04)
Page: 2 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: RENTERIA, DORA FAMILY CHILD CARE
FACILITY NUMBER: 543905345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

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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. This requirement was not met as evidenced by LPA's review of childrens' files that did not contain
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documentation of required immunizations. 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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2020
LIC809 (FAS) - (06/04)
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