153911195-11-8-2022-57-CC-JTHN-CKYPQ5-20221108103036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153911195
Report Date: 11/08/2022
Date Signed: 11/08/2022 10:30:43 AM

Document Has Been Signed on 11/08/2022 10:30 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	RODRIGUEZ, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	153911195
ADMINISTRATOR:	RODRIGUEZ, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 444-5740
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 4	DATE:	11/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Sandra Rodriguez - Licenseee		TIME COMPLETED:	10:40 AM

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On 11/08/22 Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced One year Required Inspection and was met by Licensee Sandra Rodriguez. 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. Licensee confirmed that bathroom, dining room, living room and back room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of gates, locked doors, and spinner knobs. 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.

There are no fireplaces or open face heaters in the home. 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. The home has working telephone service and LPAs confirmed the phone number is (661) 444-5740 and (661) 484-9718.

LPA discussed Safe Sleep Regulations with licensee. 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. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are 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 LIC809C).

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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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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: RODRIGUEZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 153911195
	VISIT DATE: 11/08/2022

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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required; however, 3 of 4 children files reviewed did not contain updated immunization records as required. Licensee completed Child Abuse Mandated Reporter training on 9/3/2021. Licensee’s pediatric CPR/First Aid expires 10/2024. A review of records indicates Licensee has 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. 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 deficiency was found: (see LIC809D). Appeal rights were provided to Licensee.

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: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/08/2022 10:30 AM - It Cannot Be Edited

Created By: Jessika Thompson On 11/08/2022 at 09:55 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: RODRIGUEZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 153911195
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. 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 4 of children's files reviewed (see LIC809C for further details), which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/08/2022
	Plan of Correction
1 2 3 4	Licensee stated that she will obtain updated immunization records for Child #1, Child #2 and Child #4. Upon receipt of aforementioned records, Licensee will update each child's on file PM 286, and send proof of correction (updated PM 286 and corresponding immunization records) to the Fresno Community Care Licensing Office by 12/8/2022.

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:

Jessika Thompson

LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC809 (FAS) - (06/04)

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