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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153804768
Report Date: 08/11/2021
Date Signed: 08/11/2021 01:13:40 PM

Document Has Been Signed on 08/11/2021 01:13 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CHILDREN'S PLAYHOUSEFACILITY NUMBER:
153804768
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 396-1720
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
08/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Maria RodriguezTIME COMPLETED:
01:30 PM
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On 08/10/21 Licensing Program Analyst (LPA), Jose Penate conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Rodriguez (Spanish Speaking). Days and hours of operation are Monday – Saturday; 05:00AM – 06:00PM or as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and The areas of the home that day care children will have access to are the Daycare room (garage the was converted) that includes an adjacent bathroom and a sleeping room. All other rooms are off-limits and made inaccessible child safety locks. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition at this home. No poisons were observed during the inspection.

There is a working fire extinguisher, smoke detector. Licensee did not have carbon monoxide detector powered on but did locate and plugged in immediately. There was adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (661) 396-1720.

There are 4 infants in care, LPA discussed infant under the age of 12 months they must sleep in cribs and play yards and will be kept free from all loose articles and objects while infants are sleeping. Infants shall not swaddled while in care. LPA discussed Individual Infant Sleeping Plan for infants up to 12 months of age. Infants up to 12 months of age will be placed 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. Capacity as specified on the license is being maintained.

Continued on LIC 809-C

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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 08/11/2021 01:13 PM - It Cannot Be Edited


Created By: Jose Penate On 08/11/2021 at 12:23 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: CHILDREN'S PLAYHOUSE
FACILITY NUMBER: 153804768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2021
Section Cited
CCR
102425(j)(1)

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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
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Licensee stated she will begin logging sleeping children every 15minutes and will discuss with all staff.
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records review: LPA verified all infants in care file and statement from licensee that currently 15MIN log is not being completed for children under the age of 24 months. This poses a potential health, safety, or personal rights risk to the children in care.

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Type B
08/30/2021
Section Cited
CCR1596.8662(b)(1)

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Mandated Reporter Training - On or before March 30, 2018..is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete and renew mandated reporter training every two years. from the initial mandated reporter training.
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Licensee and assistant agrees to complete the required Mandated Reporter Training and will submit proof to CCLD by the POC due date of 08/20/21.
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This requirement was not met as evidenced by: Assistant was unable to provide Mandated Reporter Training for self and licensee. This posses a potential risk to the health, safety and/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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


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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: CHILDREN'S PLAYHOUSE
FACILITY NUMBER: 153804768
VISIT DATE: 08/11/2021
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Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid is current and will expire 1/25/2023. Mandated Reporter has been not completed; LPA explained to licensee that training is required for all staff at the facility. A review of records could not verify that employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Staff files were not available for current staff at the facility (Staff #1 and #2).

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) and 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, of the California Code of Regulations, deficiencies are cited (See LIC 809-D).

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/11/2021 01:13 PM - It Cannot Be Edited


Created By: Jose Penate On 08/11/2021 at 12:00 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: CHILDREN'S PLAYHOUSE
FACILITY NUMBER: 153804768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2021
Section Cited
CCR
1597.622(a)(1)

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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
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Licensee stated she would be obtaining proof of required immunizations and place in the files for staff #1 and #2. Licensee will provide proof to the Department by POC date: 8/20/2021.
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volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by: staff #1 and #2 did not have proof of immunizations. This poses a potential risk to the health, safety, or personal rights of children in care.
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Type B
08/20/2021
Section Cited
CCR102418(g)

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Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. This requirement was not met as evidenced by: Upon children's file review, Child #1 was missing proof of MMR immunization. This is a potential risk to children in care.
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Licensee stated that mom was due to take child#1 to get the required immunizations. Licensee will obtain information of immunizations by childs representative on POC date.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/11/2021 01:13 PM - It Cannot Be Edited


Created By: Jose Penate On 08/11/2021 at 12:34 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: CHILDREN'S PLAYHOUSE
FACILITY NUMBER: 153804768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2021
Section Cited
CCR
102416.1(a)1-12

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Personnel Records. Personnel records shall be maintained on each employee. This requirement was not met as evidenced by licensee was not aware that a personnel file is required for assistants. Staff #1 and #2 does not have a file for review. Staff #1 does not have an application, criminal record statement, employee rights, acknowledgement
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Per licensee, staff #1 and #2 file will be complete and ready for review before 8/30/21. LPA will conduct a visit to ensure staff file is complete. LPA provided LIC forms for staff to complete.
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of reporting child abuse, employee rights, immunization and TB test results. This is a potential personal rights, health and safety risk to 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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


LIC809 (FAS) - (06/04)
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