153910688-3-10-2022-04-CC-AGIN-CCDSRG-20220310130621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910688
Report Date: 03/10/2022
Date Signed: 03/10/2022 01:06:33 PM

Document Has Been Signed on 03/10/2022 01:06 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:	QUEVEDO, ELSA FAMILY CHILD CARE		FACILITY NUMBER:	153910688
ADMINISTRATOR:	QUEVEDO, ELSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 396-6354
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93305
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	03/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Elsa Quevedo		TIME COMPLETED:	01:15 PM

NARRATIVE

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On 03/10/22 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensee, Elsa Quevedo. Days and hours of operation are Monday through Friday 6:00 AM to 5:30 PM.

LPA toured the home inside and outside and a census was taken of 3 children in care. Licensee confirmed that the living room, dining room, kitchen, bathroom, 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 doors and safety gates. During today’s inspection Licensee requested to make bedroom 1 off limits to daycare children as she is not utilizing it for the daycare. Licensee signed and dated the 999A Sketch in her facility and on LPA’s copy to indicate off limits to bed room one. There is no swimming pool or other bodies of water on the premises. No firearms on the premises. No poison, detergents, cleaning compounds, and other hazardous items were observed during today’s inspection. Licensee had made her cabinets inaccessible by use of safety locks in the kitchen and bathroom.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs or a fireplace in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (323) 396-6354.

There are no infants in care or enrolled at this time. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care if Licensee decides to enroll an infant. 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. Licensee understands the use of the Infant Sleep LIC9227 form. (Cont. 809C)

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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 03/10/2022 01:06 PM - It Cannot Be Edited

Created By: Araceli Gibson On 03/10/2022 at 12:31 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: QUEVEDO, ELSA FAMILY CHILD CARE	FACILITY NUMBER: 153910688
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above Licensee unable to provide evidence of Completed Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/24/2022
	Plan of Correction
1 2 3 4	Licensee agrees to provide proof of completed Mandated Reporter Training for Child Care Providers (AB1207) by POC date of 03/24/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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: QUEVEDO, ELSA FAMILY CHILD CARE	FACILITY NUMBER: 153910688
	VISIT DATE: 03/10/2022

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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 clean up 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 complete with the immunizations. Licensee was not able to provide evidence of completing the Mandated Reporter Training for Child Care providers (see 809D). Licensees’ pediatric CPR/First Aid was expires on 10/2022. A review of records indicates that all employees and/or volunteers have immunization records 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.

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: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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