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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103809921
Report Date: 07/12/2022
Date Signed: 07/12/2022 02:52:39 PM

Document Has Been Signed on 07/12/2022 02:52 PM - 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ARAGON, MARTHA FAMILY CARE HOMEFACILITY NUMBER:
103809921
ADMINISTRATOR:ARAGON, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 801-1153
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Martha AragonTIME COMPLETED:
03:30 PM
NARRATIVE
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On 7/12/22 Licensing Program Analyst, (LPA) Caroline Harris conducted an unannounced annual inspection. LPA met with Licensee, Martha Aragon. Also present was her daughter/assistant. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were five day care children present. The LPA observed the licensee to have two dogs and three birds. The pets are indoor/outdoor and are housed in off limits areas. The licensee is aware of the safety of children around animals and takes responsibility for any action taken by her pets. The LPA observed inaccessible rooms to be off limits to children by the use of door knob spinners. Upon inspection, the LPA observed the hall bedrooms to be open and accessible to children. The licensee closed the doors. The accessible rooms are the day care room, kitchen, laundry room and bathroom. The outdoor play area in the back yard is fenced. Licensee is aware that children are to be supervised when outside an unfenced play area. There are no swimming pools or other bodies of water on the premises. The LPA observed safe toys and play equipment both indoors and outside. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. Cleaning compounds, medications and other hazardous items are required to be inaccessible to children. During the inspection, the LPA observed cleaning supplies and alcohol under the kitchen sink, batteries in one bottom drawer and sharp knives in the small drawer next to the dishwasher. Laundry soap and bleach were also on a lower shelf in the laundry room that could be accessible to older children. There are no firearms or ammunition present at this facility. Fireplace is not in use during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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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Document Has Been Signed on 07/12/2022 02:52 PM - It Cannot Be Edited


Created By: Caroline Harris On 07/12/2022 at 01:31 PM
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: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Upon inspection, the LPA observed the hall bedrooms to be open and accessible to children. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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The licensee closed the doors. All of the off limits rooms had door spinners on them. The licensee agrees to write a statement that she understands that off limits rooms are required to stay closed during day care hours. This statement will be available for review by the due date of 7/26/22.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the inspection, the LPA observed cleaning supplies and alcohol under the kitchen sink, batteries in one bottom drawer and sharp knives in the small drawer next to the dishwasher. Laundry soap and bleach were also on a lower shelf in the laundry room that could be accessible to older children. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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The licensee removed the items and placed them out of reach. The licensee stated that she usually has a baby gate blocking the kitchen area and will place it up again or place latches on certain drawers or cabinets. This will be checked at a later time.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022


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Document Has Been Signed on 07/12/2022 02:52 PM - It Cannot Be Edited


Created By: Caroline Harris On 07/12/2022 at 01:31 PM
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: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the licensee did not have fitted sheets for the infant cribs. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/19/2022
Plan of Correction
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The licensee agrees to purchase tight fitting sheets/covers for the infant mattress cribs and have available for review by the due date of 7/19/22.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
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 is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the licensee was not logging 15 minute checks for infants in care. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2022
Plan of Correction
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The licensee aggress to immediately start logging every 15 minutes, when infants 0-24 months old are sleeping and follow the Safe Sleep requirements. These logs will be available for review.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2022 02:52 PM - It Cannot Be Edited


Created By: Caroline Harris On 07/12/2022 at 01:31 PM
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: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022

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
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Based on record review, the licensee did not comply with the section cited above as the licensee's assistant did not have proof of immunizations available for review. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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The licensee will get copies of immunizations for her assistant and have them available for review by the due date of 7/26/22. A return visit will take place in order to clear this deficiency.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the licensee did not have proof of immunizations for children in the files. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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The licensee will get copies of immunizations for all non school age children and have them available for review by the due date of 7/26/22. A return visit will take place in order to clear this deficiency.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2022 02:52 PM - It Cannot Be Edited


Created By: Caroline Harris On 07/12/2022 at 01:31 PM
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: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) 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. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the licensee did not have documentation of transcribed immunizations for children not enrolled in school. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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The licensee agrees to get copies of immunizations for non school age children and transcribe them onto blue cards. This will be available for review by the due date of 7/26/22. A return visit will take place in order to clear this deficiency.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022


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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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921
VISIT DATE: 07/12/2022
NARRATIVE
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The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. There are no stairs in the home. There is a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained.

LPA reviewed five children’s files. Not all required licensing documents were observed in each of the children’s files. The licensee did not maintain documentation of immunizations for non school age children either. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. Fire drills are conducted and documented with the date, time and how many children present, every six months. Licensee is aware that children are never to be left in parked vehicles. 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. 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. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Pediatric CPR/First Aid are current and expire on 7/31/23. Licensee does maintain documentation of immunizations against pertussis, measles and influenza for herself but not her staff. Days and hours of operation are Monday – Friday; 6:00 AM – 7:00 PM or as arranged.

An exit interview was conducted with the Licensee. LPA reviewed with licensee the Mandated Child Abuse Reporter Training (AB 1207), which the licensee completed on 6/29/21. It is required to be updated every two years.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
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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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921
VISIT DATE: 07/12/2022
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. There is one crib or play yard for each 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. Provider physically checks on sleeping infants (0-24 months) every fifteen minutes but did not document these checks. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Information on Lead Poisoning was also provided to the licensee and she was informed that the information is required to be posted on the parent board. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page): 809 D An exit interview was conducted and a copy of this report (along with appeal rights) was provided to the licensee, Martha Aragon and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice of Site Visit form was provided to the licensee and must remain posted for 30 days.

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.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
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