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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910649
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:34:12 AM

Document Has Been Signed on 11/21/2022 11:34 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MATA, ROSALINDA FAMILY CHILD CAREFACILITY NUMBER:
203910649
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Rosalinda MataTIME COMPLETED:
11:35 AM
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On 11/21/2022, Licensing Program Analyst (LPA) Ka Vang and Licensing Program Manager (LPM) Luisa Gavoutian conducted an unannounced Annual Required Inspection and was met by Licensee, Rosalinda Mata. Days and hours of operation are Monday through Friday, from 7:30 AM-5:30 PM.

The home has a working telephone service and LPA confirmed the phone number is 559-232-0901.

LPA and LPM toured the home inside and outside. Census was taken and there four day care children present. Current facility sketch (LIC 999A) was reviewed, and Licensee confirmed that the living room, kitchen, dining, daycare room and daycare bathroom are used for providing care and accessible to day care children. All other rooms are off-limits and made inaccessible to children in care by the use of plastic doorknob cover. There is a fireplace located in the living room but made inaccessible to the children by the use of a fire screen. Licensee confirmed that there are no firearms in the home. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are inaccessible.

This is a 1 story home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills are conducted and documented with the date, time and how many children present, every six months.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There are two dogs in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. The backyard is made inaccessible to children in care. LPA and LPM observed an in-ground pool in the backyard. Licensee made the backyard inaccessible to children in care. Licensee stated she locked the slide door at all time and she also installed an alarm to ensure that if the children open the slide door, the alarm will sound. LPA observed the alarm is working.

Currently, Licensee did not have infant enrolled in the facility. Licensee is aware that there shall be one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are



(Continued on LIC 809-C).
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MATA, ROSALINDA FAMILY CHILD CARE
FACILITY NUMBER: 203910649
VISIT DATE: 11/21/2022
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sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. LPA and LPM advised licensee that she is required to document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a sleeping log. Infants can be visually observed through an open door if sleeping in a separate room.

LPA discussed the safe sleep regulations with licensee 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 resources. 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 that licensee register all infant devices with the CPSC to be notified of any recalls on her 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. Capacity as specified on the license is being maintained.

LPA and LPM reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter training was completed on 03/21/2022. Licensee’s pediatric CPR/First Aid expires on 08/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

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) not provided but the policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding

(Continued on LIC-809C).

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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: MATA, ROSALINDA FAMILY CHILD CARE
FACILITY NUMBER: 203910649
VISIT DATE: 11/21/2022
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ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301(voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: 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.



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, during today's inspection there is no deficiencies are cited.

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 licensee Rosalinda Mata.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
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