153908434-1-24-2022-04-CC-AGIN-CAYTFG-20220124134130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153908434
Report Date: 01/24/2022
Date Signed: 01/24/2022 01:41:39 PM

Document Has Been Signed on 01/24/2022 01:41 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:	PATINO, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	153908434
ADMINISTRATOR:	PATINO, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 319-2180
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	01/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Maria Patino		TIME COMPLETED:	01:55 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 01/24/22 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensees, Maria Patino and her spouse Jose Patino. Days and hours of operation are Monday through Friday 7:00AM to 6:00 PM.

LPA toured the home inside and outside and a census was taken of 1 child in care. Licensee confirmed that the living room, dining room, kitchen, bathroom, day care room, and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locks and spinner knobs. There is no swimming pool or other bodies of water on the premises. Firearms and ammunition are stored and locked separately on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. An open face heater in the daycare room is disconnected. There are stairs and a fireplaces in the home both have safety gates and made inaccessible to children. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (661) 319-2180.

There are currently no infant in care, but has one infant pending enrollment next month. LPA discussed Safe Sleep Regulations with licensee and provided an LIC 9227 form. 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 every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Infants up to 12 months of age are placed on their backs for sleeping.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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 5

Document Has Been Signed on 01/24/2022 01:41 PM - It Cannot Be Edited

Created By: Araceli Gibson On 01/24/2022 at 01:12 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: PATINO, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 153908434
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 3 out of 4 children had incomplete files missing LIC 700, LIC 995A LIC 627 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	LIcensee agreed to submit proof of Licensing forms for children's records by Plan of Correction date.

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:

Susie Fanning

LICENSING EVALUATOR NAME:

Araceli Gibson

LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: PATINO, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 153908434
	VISIT DATE: 01/24/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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. The outdoor play area in the backyard is fenced. LPA observed and discussed best practice to do a brief clean up weekly to assure outdoor areas are clean and safe for children to use. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were incomplete with exception of one child’s records (see 809D). Licensee, completed the Mandated Reporter Training on 05/27/21. Licensees’ pediatric CPR/First Aid expires on 04/14/2023. Licensee agreed to keep records for all employees and/or volunteers of immunizations on file for influenza, pertussis and measles.

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, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5