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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153905200
Report Date: 06/24/2021
Date Signed: 06/24/2021 10:49:03 AM

Document Has Been Signed on 06/24/2021 10:49 AM - 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:SIXTOS, IRENE FAMILY CHILD CAREFACILITY NUMBER:
153905200
ADMINISTRATOR:SIXTOS, IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 721-2118
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Irene SixtosTIME COMPLETED:
11:00 AM
NARRATIVE
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On 6/24/21 Licensing Program Analysts, (LPAs) Caroline Harris and Roman Iglesias conducted an unannounced annual inspection. LPAs met with Licensee, Irene Sixtos. Also present was her husband and son. LPAs conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The LPAs 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 six day care children present. The LPA observed the licensee to have one cat and one dog. The pets are indoor and outdoors. 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 and baby gates. The accessible rooms were the living room, hall bathroom and front gated yard. Licensee is aware that children are to be supervised when outside an unfenced play area. The LPAs 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 were inaccessible to children. There are no firearms or ammunition present at this facility. There is no fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. 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. There are no swimming pools or other bodies of water on the premises.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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 06/24/2021 10:49 AM - It Cannot Be Edited


Created By: Caroline Harris On 06/24/2021 at 09:59 AM
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: SIXTOS, IRENE FAMILY CHILD CARE
FACILITY NUMBER: 153905200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2021
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review as specified in H&S Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption.
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Licensee's unfingerprinted person left the home during today's visit. The licensee understands that no one is allowed to be present in the home until fingerprint cleared or have a clear exemption and is associated with her facility.
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This requirement was not met as evidenced by the LPA's observing an unfingerprinted person present in the home and the licensee's statement of them being there for a couple of months. This is an immediate risk to the health, safety or personal rights of children in care. Therefore, a civil penalty is assessed ($100.00 per violation per day for a maximum of five days by the Department).
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The licensee agreed to write a statement that she understands the requirements for a person being fully fingerprint cleared.

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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:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2021


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: SIXTOS, IRENE FAMILY CHILD CARE
FACILITY NUMBER: 153905200
VISIT DATE: 06/24/2021
NARRATIVE
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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 "Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months."

A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

A copy of this report, along with appeal rights, was provided to the licensee and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form is required to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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: SIXTOS, IRENE FAMILY CHILD CARE
FACILITY NUMBER: 153905200
VISIT DATE: 06/24/2021
NARRATIVE
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LPA reviewed four children’s files. All required licensing documents were observed in each of the children’s files, including a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee also maintains documentation of immunizations for the children. Incidental Medical Services (IMS) policy was discussed. 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. All adults who reside or work in the home are to have a criminal record clearance or exemption. Upon inspection, the licensee's son, Brandon Sandoval, was present in the home. The licensee stated that her son had returned to the home approximately two months ago. Brandon Sandoval is unfingerprint cleared. 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 3/20/23. Licensee does maintain documentation of immunizations against pertussis, measles and influenza for herself and staff. Hours of Operation are Monday through Saturday, 4:30 AM to 7:00 PM and other hours 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 1/10/20. It is required to be updated every two years. There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. 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.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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