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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911630
Report Date: 05/12/2022
Date Signed: 05/12/2022 12:26:40 PM

Document Has Been Signed on 05/12/2022 12:26 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:JONES, CLARISSA FAMILY CHILD CAREFACILITY NUMBER:
243911630
ADMINISTRATOR:JONES, CLARISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 445-1670
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
05/12/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Clarissa Jones - LicenseeTIME COMPLETED:
12:45 PM
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On 5/12/22 Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced Post Licensing inspection. The purpose of today's inspection was to conduct a post licensing follow-up on the initial pre-licensing inspection that took place on 9/27/21. LPA met with Licensee, Clarissa Jones. A tour of the facility inside and outside was made. One day care child was present on this date. The accessible rooms are the living room, kitchen, hall bathroom and backyard. Off-limit rooms are made inaccessible by use of child safety gates. Licensee’s CPR and first aid training expires 2/19/24. Licensee’s AB 1207 Mandated Reporter training was completed on 10/28/21. Licensee is aware that a child's roster is to be maintained. The required forms are posted. LPA reviewed Safe Sleep regulations, required forms for children’s files and required forms for day care staff files. Licensee has two cats that are accessible to day-care children. Licensee accepts liability of any action taken by pets.

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 is being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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: JONES, CLARISSA FAMILY CHILD CARE
FACILITY NUMBER: 243911630
VISIT DATE: 05/12/2022
NARRATIVE
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LPA Joseph Pacheco informed licensee Clarissa Jones that this report dated 5/12/22 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Joseph Pacheco informed the licensee to provide a copy of this licensing report dated 5/12/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Licensee, Clarissa Jones.

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.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/12/2022 12:26 PM - It Cannot Be Edited


Created By: Joseph Pacheco On 05/12/2022 at 11:59 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: JONES, CLARISSA FAMILY CHILD CARE
FACILITY NUMBER: 243911630

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2022
Section Cited
CCR
102370(d)(1)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as
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Licensee stated she will have Adult #1 go and get fingerprint cleared as required and submit proof to Community Care Licensing by 5/13/22.
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evidenced by: Based on Licensee stating that Adult #1 who resides in the home has not been fingerprint cleared as required by regulations. This poses an immediate health, safety or personal rights risk to children in care.
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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:Diana deLeon
LICENSING EVALUATOR NAME:Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022


LIC809 (FAS) - (06/04)
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