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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543906047
Report Date: 01/15/2020
Date Signed: 01/17/2020 01:17:12 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:VELAZQUEZ, MARIA DEL FAMILY CHILD CAREFACILITY NUMBER:
543906047
ADMINISTRATOR:VELAZQUEZ, MARIA DELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 740-8209
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 7DATE:
01/15/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Del Velazquez - Licensee TIME COMPLETED:
01:15 PM
NARRATIVE
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An unannounced Annual/Random Inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA with met with Licensee Maria Del Velazquez and a census was taken. A tour of the facility was made. Background clearances were discussed. Licensee has current pediatric CPR and First Aid that expire on 09/07/21. Accessible areas of the home are the living room, dining room, kitchen, playroom, bedroom #1 and hallway bathroom. Off-limit rooms are made inaccessible by spinning door knob covers, which were observed by LPA on this date. The home is clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. Safe, healthful, and comfortable accommodations, furnishings, toys and equipment were observed. There is a working telephone. Licensee has one dog that is accessible to children. Licensee accepts full liability for any action taken by family pet. A current roster of children in care is maintained. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative. Licensee ensures that children in care are supervised at all times. Fire and disaster drills are conducted at least once every six months, and documented with the date and time. There are no bodies of water on the premises. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored where they are inaccessible to children. Facility has required fire extinguisher and smoke detector, both meet State Fire Marshall standards. Facility has one functioning carbon monoxide detector that meets statutory requirements. Licensee understands children may not be left in parked vehicles. Safe sleep practices for infants was discussed and LPA provided the licensee with a handout. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is subscribed to receive updates via email as of today. Licensee is aware that forms and updated information may be obtained on the Department’s website (www.ccld.ca.gov).


Continued on LIC809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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 4
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: VELAZQUEZ, MARIA DEL FAMILY CHILD CARE
FACILITY NUMBER: 543906047
VISIT DATE: 01/15/2020
NARRATIVE
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Child Abuse Mandated Reporter training was discussed. Licensee was advised that this certification must be renewed every two years. Licensee understands that it is her responsibility to stay current with regulations. Licensee is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care have not been recalled.

Incidental Medical Services (IMS) are not currently being provided. Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Licensee was advised that the Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).


Hours of operation are Monday through Friday from 6:00 AM to 6:00 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

In exit interview the licensee was advised of appeals rights and was provided with Appeals Rights. Licensee was also advised that this report with Type A Deficiencies must be posted for 30 days where parents may easily view and filed in facility file for public review for 3 years.



Licensee is advised to make this licensing report accessible to the public and to provide copies of this licensing report and 809D with Type A citation to parents/legal guardians of children in care and to parents/legal guardians of children newly enrolled at the facility during the next 12 months. Licensee is to keep verification of receipt (LIC9224) in each child's file at the facility. An LIC9224 and Assembly Bill 633 fact sheet was provided to licensee on this date.

LIC 9213 NOTICE OF SITE VISIT FORM IS 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: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: VELAZQUEZ, MARIA DEL FAMILY CHILD CARE
FACILITY NUMBER: 543906047
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2020
Section Cited

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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA's observations and records review.
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 During today’s inspection, LPA observed Luisa Medina providing care to children within the family child care home. During records review, LPA confirmed that Ms. Medina is not fingerprint cleared and/or associated to the FCCH as required. Ms. Medina and the licensee affirmed that today was Ms. Medina's second day working at the FCCH. This poses an immediate risk to the health, safety, or personal rights of children in care. A civil penalty of $200.00 was assessed today.
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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: 01/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: VELAZQUEZ, MARIA DEL FAMILY CHILD CARE
FACILITY NUMBER: 543906047
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2020
Section Cited

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Immunizations. Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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This requirement was not met, as during today's inspection, the licensee was unable to provide immunization records for Child #1 and Child #2. This poses a potential risk to the health, safety, or personal rights of children in care.
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Type B
01/30/2020
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 (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.
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This requirement was not met as during today's inspection, Licensee was unable to provide LPA with proof of completetion of an AB1207 certified Child Abuse Mandated Reporter course.
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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: 01/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2020
LIC809 (FAS) - (06/04)
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