203911297-1-22-2024-04-CC-DJIZ-CZQVH9-20240122152647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203911297
Report Date: 01/08/2024
Date Signed: 01/22/2024 03:26:56 PM

Document Has Been Signed on 01/22/2024 03:26 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:	ROLLINS, MARTHA FAMILY CHILD CARE		FACILITY NUMBER:	203911297
ADMINISTRATOR:	ROLLINS, MARTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 718-3449
CITY:	MADERA	STATE: CA	ZIP CODE:	93637
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	01/08/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Martha Rollins		TIME COMPLETED:	11:25 AM

NARRATIVE

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On 01/08/24 Licensing Program Analyst (LPA) Denisia Jimenez conducted an unannounced Required 1-year inspection and met with Licensee, Martha Rollins. Also, present was the licensee’s husband and assistant. LPA took a census and there were 6 children and 1 infant in care.

LPA confirmed with licensee hours of operation are Monday through Friday 7:30 AM to 5:30 PM and other hours as arranged. LPA also confirmed the family childcare home has a working telephone service, and Licensee confirmed the phone number is 559-718-3449.

LPA and licensee began the tour of the home inside and outside. Current facility sketch reviewed, and Licensee confirmed that the kitchen, nook, dining room, living room, bedroom #1, bedroom #2 and bathrooms adjacent to each bedroom noted are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible using spinner knob covers and a gate.

The licensee stated there is a hot tub with no water outside in the backyard. LPA observed a hot tub in the backyard which is made inaccessible by a locked gate and the hot tub has a tight fitted locked cover. LPA did not observe any bodies of water. Licensee stated 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.

The is a fireplace located in the living room that is made inaccessible by a glass screen 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 were observed. Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained.

The outdoor play area in the backyard is fenced and there are no hazards to day care children. The Licensee ensures that children in care are supervised at all times. The licensee has 2 dogs that are inaccessible to children and 3 cats that are accessible to the children. The 2 dogs are inside and are in the inaccessible areas. The licensee is aware of child safety around pets and accepts responsibility for any action taken by pets. The licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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 01/22/2024 03:26 PM - It Cannot Be Edited

Created By: Denisia Jimenez On 01/08/2024 at 10:43 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: ROLLINS, MARTHA FAMILY CHILD CARE	FACILITY NUMBER: 203911297
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2024

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 observation, interview, and record review, the licensee did not comply with the section cited above. The licensee could not provide LPA with her current mandated reporter training certificate and the assisant has not completed the mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/22/2024
	Plan of Correction
1 2 3 4	The licensee will provide the LPA with her and her assistant's Mandated Reporter Training by 01/22/24.

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:

Juvenal Moctezuma

LICENSING EVALUATOR NAME:

Denisia Jimenez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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: ROLLINS, MARTHA FAMILY CHILD CARE	FACILITY NUMBER: 203911297
	VISIT DATE: 01/08/2024

NARRATIVE

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There is currently 1 infant in care that will be turning 2 years olds next month. 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. The 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.
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 resource. LPA also informed licensee [or facility representative] 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.

The licensee has a current roster of the children. LPA reviewed 6 children’s records and 2 out of the 6 records were missing their immunizations and 1 record was missing the Affidavit Liability Insurance form. The rest of the children’s records contained all emergency information specified by regulation. LPA explained the importance of having all children’s records information specified by regulation. The licensee understood and explained that she is in the process of organizing her paperwork and that she will go through each children’s file and update any missing forms. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 9/21/21. The licensee stated that she did complete the Mandated Reporter Training but could not provide proof of completion to the LPA. The licensee’s assistant also has not completed the Mandated Reporter Training. The licensee stated the assistant is in the process of having it completed. LPA explained to the licensee the importance of having the Mandated Reporter Training completed. LPA will issue a Type B citation. Licensee’s pediatric CPR/First Aid expires on 03/2025. 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.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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: ROLLINS, MARTHA FAMILY CHILD CARE	FACILITY NUMBER: 203911297
	VISIT DATE: 01/08/2024

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding 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/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Exit interview conducted and report was reviewed with licensee, Martha Rollins. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page).

Licensee was provided 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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC809 (FAS) - (06/04)

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