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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910440
Report Date: 11/15/2023
Date Signed: 11/15/2023 02:32:36 PM

Document Has Been Signed on 11/15/2023 02:32 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GIRON, TEODORA FAMILY CHILD CAREFACILITY NUMBER:
203910440
ADMINISTRATOR:GIRON, TEODORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 718-1067
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
11/15/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Tedora GironTIME COMPLETED:
03:00 PM
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On 11/15/2023 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez, conducted an unannounced Annual Required Inspection and was met by Licensee, Teodora Giron. LPA explained the reason for the visit. Licensee is Spanish Speaking and LPA Vega-Gonzalez assisted with interpretation. Days and hours of operation are Monday through Saturday from 4:00am to 6:00pm. Licensee provides overnight care from 6:00pm to 3:00am. LPA reviewed overnight care regulations with licensee.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the living room, dining room, kitchen, hallway bathroom and fenced front yard are accessible to children. All other rooms are off-limits and made inaccessible by use of door knob spinners. LPA did not observe a swimming pool or other bodies of water on the premises, and Licensee stated that here are no swimming pool or other bodies of water. There are no firearms or ammunition on the premises. LPA did not observe any poisons during the inspection. Detergents, cleaning compounds, medication and other hazardous items were made inaccessible during the inspection. During the inspection LPA observed the following: In the kitchen: 2 bottles of whey protein, a bottle of fiber powder. In the living room LPA observed a dozen packet COVID test kit and two first aid kits. LPA observed Licensee place whey protein, fiber, first aid kit, and covid test in an inaccessible area to children in care. LPA reviewed best practices and regulations with licensee. In the front yard LPA observed a play structure on the side of the house. LPA observed that the slide was broken. LPA observed that the slide was too close to a cement wall. LPA observed that the stairs were too close to the house. LPA spoke to LPA about best practices, to have play structure in an area that is open and has space for children.

LPA did not observe any pets. Licensee informed LPA that she has four small dogs and one large dog. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets.

Continue on LIC809-C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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Document Has Been Signed on 11/15/2023 02:32 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 11/15/2023 at 01:56 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: GIRON, TEODORA FAMILY CHILD CARE
FACILITY NUMBER: 203910440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observed, the licensee did not comply with the section cited above in [count] out of LPA observed the following that were accessible to children in care. In the kitchen: 2 bottles of whey protein, a bottle of fiber powder. In the living room LPA observed a dozen packet COVID test kit and two first aid kits. In the front yard LPA observed a play structure on the side of the house. LPA observed that the slide was broken. LPA observed that the slide was too close to a cement wall. LPA observed that the stairs were too close to the house. LPA spoke to LPA about best practices, to have play structure in an area that is open and has space for children, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2023
Plan of Correction
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Licensee stated that she will supervise children and ensure that children do not play on play structure while play structure deficiency is being corrected. Licensee stated that slide will be removed and area of slid will be blocked off. Licensee stated that play structure will be moved to an area that has more room for children. Licensee will provide proof to the Department. LPA observed that Licensee removed all other "Keep out of Reach of Children" items to an area inaccessible to children on today's inspection date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023


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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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GIRON, TEODORA FAMILY CHILD CARE
FACILITY NUMBER: 203910440
VISIT DATE: 11/15/2023
NARRATIVE
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LPA did not observe any 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. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. LPA did not observe any stairs in this home. The home has working telephone service and LPA confirmed the phone number is (559)718-1067.

LPA did not observe any infants in care during inspection. Licensee sated that they are not currently caring for any infants. LPA discussed Safe Sleep Regulations with licensee. LPA reviewed infant regulations with Licensee. 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. License stated that infants are not swaddled while in care. Licensee 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. The outdoor play area in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 8/22/22. Licensee’s pediatric CPR/First Aid expires on 3/18/2025. 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.


Continue on LIC809-C
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GIRON, TEODORA FAMILY CHILD CARE
FACILITY NUMBER: 203910440
VISIT DATE: 11/15/2023
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Licensee Teodora Giron 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, 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.

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.

LPA discussed the safe sleep regulations with Licensee Teodora Giron and 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 infants devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process



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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Teodora Giron

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5