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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909735
Report Date: 03/16/2023
Date Signed: 03/16/2023 04:43:15 PM

Document Has Been Signed on 03/16/2023 04:43 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PENA, ROBBIN FAMILY CHILD CAREFACILITY NUMBER:
153909735
ADMINISTRATOR:PENA, ROBBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 746-2841
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Robbin Pena -Licensee TIME COMPLETED:
04:55 PM
NARRATIVE
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On 3/16/2023, Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Annual Required Inspection. LPA was initially met by the licensee's daughter, Staff #2 who solely providing care to three children. Licensee Robbin Pena arrived shortly thereafter with an additional three children. Days and hours of operation are Monday through Friday from 6:00AM -6:00 PM. LPA toured the home inside and outside and a census was taken. Licensee’s current facility sketch was reviewed, and Licensee confirmed that the kitchen, bathroom, dining room, day-care room and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of baby gates and locked doors. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. Today, LPA observed that the licensee has removed flooring from the day-care room leaving only the concrete exposed; licensee stated that she will be having hardwood installed soon. LPA advised licensee that the day-care room should not be utilized for day-care purposes until installation is completed. The fireplace located in the living room is made inaccessible by glass door and will not be in use during day-care hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. Licensee's phone number, 661-437 5787, is on file with the Department. Currently, there are no infants in care. LPA reviewed safe sleep regulations with licensee. Additionally, LPA and licensee 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. 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 (see next page, LIC809-C).
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 03/16/2023
NARRATIVE
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Capacity as specified on the license is being maintained. Licensee was unable to provide proof of a fire & disaster drill completed within the last six months.

LPA reviewed a sample of children’s files and observed files were complete with emergency and immunization information as required. Licensee’s Mandated Reporter Training was completed 5/11/2022. Licensee's pediatric CPR/First Aid certification expires 6/9/2024. A review of records indicates that the licensee has immunization records on file for influenza, pertussis and measles. However, during file review today, LPA found that Staff #2 does not have proof of CPR, Mandated Reporter training, or proof of immunization records on file.

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 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.

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 deficiencies are being cited: (see next page, LIC809 D). Licensee was provided a copy of appeal rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/16/2023 04:43 PM - It Cannot Be Edited


Created By: Jessika Thompson On 03/16/2023 at 03:32 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

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 she was unable to provide proof of a documented fire and disaster drill today. This poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 03/16/2023
Plan of Correction
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Licensee completed a fire and disaster drill during today's inspection. Thereafter, she logged the drill and re-posted the log to her parent's board. Additionally, licensee watched Community Care Licensing Video titled "Disaster Planning and Fire Safety." Lastly, Licensee stated that she will implement a system to remind her to complete a fire and disaster drill at least once every six months. Deficiency cleared during inspection.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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.

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 Staff #2 has not completed Child Abuse Mandated Reporter training as required. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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Licensee stated that Staff #2 will complete an AB1207 certified Child Abuse Mandated Reporter course. This training can be accessed by logging on to the following website: mandatedreporterca.com. Upon completion, licensee will submit a copy of certification to the Fresno Community Care Licensing (CCL) Office, by 4/14/2023.
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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 03/16/2023 04:43 PM - It Cannot Be Edited


Created By: Jessika Thompson On 03/16/2023 at 03:32 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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 she was unable to provide proof of CPR and first aid certification for Staff #2, who was observed to be alone and caring for children for a portion of today's inspection. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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Licensee stated that Staff #2 will complete an EMSA approved children's pediatric CPR and first aid course, and send proof of completion to the Fresno CCL office by 4/14/2023.
Type B
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

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 today, LPA observed the accessible day-care room, which was filled with toys and play equipment, to be absent of adequate flooring (see LIC809 for further details). This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/16/2023
Plan of Correction
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Licensee stated that children will not utilize and/or occupy the day-care room until adequate flooring is installed. During today's inspection, licensee placed a baby gate in her hallway, thereby restricting access to the day-care room. Indoor play will take place in the licensee's living room. Licensee stated that she will contact licensing once she is ready to utilize the day-care room again (upon flooring installation). Deficiency cleared during inspection.
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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023


LIC809 (FAS) - (06/04)
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