243910735-2-17-2023-04-CC-KVAG-CP5TZK-20230217141029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243910735
Report Date: 02/17/2023
Date Signed: 02/17/2023 02:10:42 PM

Document Has Been Signed on 02/17/2023 02:10 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:	GOMEZ, PAULINE FAMILY CHILD CARE		FACILITY NUMBER:	243910735
ADMINISTRATOR:	GOMEZ, PAULINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 769-4394
CITY:	ATWATER	STATE: CA	ZIP CODE:	95301
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 15	DATE:	02/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Pauline Gomez		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/17/2023, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensee, Pauline Gomez. Present during today’s inspection, also licensee’s Assistants: Staff #2 and Staff #3. Days and hours of operation are Monday through Friday, from 8:00 AM-5:00 PM. The facility has a working telephone service and LPA confirmed the phone number is 209-769-4394. LPA toured the home inside and outside. Census was taken and there were 15 day care children present. A deficiency of Type B issued during today’s inspection as it posed a potential health, safety, or personal rights risk to persons in care. Current facility sketch (LIC 999A) was reviewed, and licensee confirmed the front room, kitchen, dining room, recreation classroom and the hallway bathroom are used for providing care and accessible to day care children. All other rooms are off-limits and made inaccessible as all the doors were all locked. There is a fireplace located in the living room but made inaccessible to the children by used of a fire screen. 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 single-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 facility. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. The backyard of the home was off limited to children in care by the used of slide door locked at all time. LPA observed an above ground swimming pool and spa in the off-limit backyard of the home and the pool and spa meet the statutory regulation. The outdoor play area behind the recreation room is the play area for the children to use and it fenced from the off-limit backyard. (Continued on LIC809-C).

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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 02/17/2023 02:10 PM - It Cannot Be Edited

Created By: Ka Vang On 02/17/2023 at 12:47 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: GOMEZ, PAULINE FAMILY CHILD CARE	FACILITY NUMBER: 243910735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2023

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 reviewed, licensee did not comply with the section cited above. LPA observed Staff #2 and Staff #3 did not have a renewal mandated reporter training (AB1207) every two years which poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 03/17/2023
	Plan of Correction
1 2 3 4	Per licensee, she will have S2 and S3 complete their renewal mandated reporter training (AB1207) by 03/17/2023 as S2 and S3 will be on vacation. Licensee agreed to submit proof of correction (POC) verify that S2 and S3 complete their mandated reporter training (AB1207) to Community Care Licensing (CCL)-Fresno Office by 03/17/2023.

Type B

Section Cited

CCR

102416.5(d)(2)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, licensee did not comply with the section cited above. During indoor inspection, LPA conducted census and observed 15 children present in the daycare facility with licensee and her two Assistants which poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 03/17/2023
	Plan of Correction
1 2 3 4	Part of licensee's plan of correction (POC), licensee immediately contacted Child #3, Child #5, and Child #6 parents and uring inspection, all three parents picked up the children from the facility. Licensee then within capacity ration of 12 children with three staff. Per licensee, she will submit proof of correction of how her facility will maintain the capacity ration of no more than 14 children to Community Care Licensing (CCL)-Fresno by 03/17/2023.

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:

Rene Mancinas

LICENSING EVALUATOR NAME:

Ka Vang

LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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: GOMEZ, PAULINE FAMILY CHILD CARE	FACILITY NUMBER: 243910735
	VISIT DATE: 02/17/2023

NARRATIVE

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Licensee has one infant (Child #6) enrolled in the facility. Licensee understands that there is one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. LPA 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 they register all infant devices with the CPSC to be notified of any recalls on their 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.
LPA 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 02/15/2023. Licensee’s pediatric CPR/First Aid expires on 06/2023. Staff #2’s did not have a renewal Mandated Reporter training in file. Staff #3 did not have a renewal Mandate Reporter training in file. A deficiency of Type B was issued during today's inspection as it posed a potential health, safety, or personal rights risk to persons in care. 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.

(Continued on LIC809-C).

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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: GOMEZ, PAULINE FAMILY CHILD CARE	FACILITY NUMBER: 243910735
	VISIT DATE: 02/17/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed, and facility is not providing IMS. 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 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, the following deficiencies are being cited during today’s inspection. 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. Exit interview conducted and report was reviewed with licensee Pauline Gomez.

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

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