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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503910731
Report Date: 06/14/2021
Date Signed: 06/14/2021 12:33:34 PM

Document Has Been Signed on 06/14/2021 12:33 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:SALDATE, CLEMENTINA FAMILY CHILD CAREFACILITY NUMBER:
503910731
ADMINISTRATOR:SALDATE, CLEMENTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 702-1775
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
06/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Clementina SaldateTIME COMPLETED:
12:45 PM
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On 06/14/2021 Licensing Program Analysts (LPAs), Robert Gutierrez and Kari McWilliams conducted an unannounced Annual Required Inspection and was met by Licensee, Clementina Saldate. Also present was Staff #1 (S1). Days and hours of operation are Monday – Friday 6:00 AM – 6:00 PM.

LPAs toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen, dining room, living room, office, hallway bathroom and the side yard are accessible to children. Living room #1 shall no longer be accessible to children in care. All other rooms are off-limits and made inaccessible by use of children safety gates. The swimming pool located in the backyard has a pool cover that can support the weight of an adult. 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.

There are no 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. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPAs confirmed the phone number is (209) 702-1775.

There are currently no infants in care. LPAs discussed Safe Sleep Regulations with licensee. There are a total of three play yards at the facility. The play yards are kept free from all loose articles and objects. There are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Licensee understands she must physically check 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 sleep in the living room. Infants up to 12 months of age are placed on their backs for sleeping.

Continued on 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Robert Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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: SALDATE, CLEMENTINA FAMILY CHILD CARE
FACILITY NUMBER: 503910731
VISIT DATE: 06/14/2021
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Licensee stated she does not transport children but understands car seats are used for transportation purposes only and are not used for sleeping children. The side yard of the play area fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPAs reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s and S1 Mandated Reporter Training was completed on 11/19/2018. Licensee’s pediatric CPR/First Aid expired on 03/28/2021. 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.



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 deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of 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: Susie Fanning
LICENSING EVALUATOR NAME: Robert Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/14/2021 12:33 PM - It Cannot Be Edited


Created By: Robert Gutierrez On 06/14/2021 at 11:46 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: SALDATE, CLEMENTINA FAMILY CHILD CARE
FACILITY NUMBER: 503910731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2021
Section Cited
HSC
1596.8662(3)

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Current proof of completion for each licensed child care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.
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License stated she and S1 shall take this training and send a certificate to the Community Care Licensing (CCL) office located in Fresno. This correction shall be submitted by the given due date.
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This requirement is not met as evidenced by a interview conducted with the licensee during today’s inspection. Upon inspection, licensee stated she has not renewed her or S1 mandated reporter training certificate. This poses as a potential risk to the health, safety, or personal rights of children in care.
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Type B
07/30/2021
Section Cited
CCR102416(c)

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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee stated she shall enroll into an approved Title 22 regulations CPR course. Once this course is completed licensee shall send a current CPR card to the Community Care Licensing (CCL) office by the given due date.
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This requirement is not met as evidenced by observation and records review conducted during today’s inspection. Licensee CPR card expired 03/28/2021. This poses as a potential risk to the health, safety, or personal rights of 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:Susie Fanning
LICENSING EVALUATOR NAME:Robert Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2021


LIC809 (FAS) - (06/04)
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