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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543904138
Report Date: 05/12/2022
Date Signed: 05/12/2022 01:45:54 PM

Document Has Been Signed on 05/12/2022 01:45 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:CHAVEZ, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
543904138
ADMINISTRATOR:CHAVEZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 793-1239
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/12/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Chavez, Guadalupe TIME COMPLETED:
02:00 PM
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On 5/12/2022, Licensing Program Analyst (LPA) conducted a Case Management Plan of Correction inspection. The purpose of the inspection was to review the Plan of Correction for the deficiencies cited on 4/11/2022. Today, LPA met with licensee Guadalupe Chavez. LPA toured the facility and a census was taken.

On 4/11/2022, LPA Ocegueda cited licensee a Type B deficiency for Admission Procedures and Authorized Representative Rights under the California Code of Regulations 102419(d)(1). During file review, LPA Ocegueda observed that three children had LIC 995A Family Child Care Notification of Parents Rights form missing from their file. Other forms were missing as well (see 809-D, dated 4/11/2022). LPA provided licensee with a list of forms and documentation that should be in each child’s file. Today, LPA reviewed children’s files and observed that all required forms and documents (including LIC 995A) were in the files for children in care today and on 4/11/2022 (child #1, #2, #3). Technical assistance was provided to licensee to assist her in maintaining children’s files complete and organized. The deficiency for this violation cited on 4/11/2022 was cleared today.

Also cited on 4/11/2022, was a Type B deficiency for staff #1 and licensee missing the Mandated Reporter Training (AB1207) certificate that is required to be completed and current under Health and Safety Code 1596.8662. Licensee’s certificate was expired and staff #1 had not completed it at all. Today, LPA reviewed the files for staff #1 and licensee and observed that certificate AB1207 was completed on 4/13/2022. A general training certificate was not provided and staff #1 logged on to show that she had completed the general training as well. LPA also reviewed all staff files to ensure that required forms and documents were available for Department review. Technical assistance was provided to licensee to assist her in ensuring that she understood all required forms and documents that should be in her and staff files. Deficiency for this violation was cleared today.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited today.

An exit interview was conducted with licensee. Notice of Site Visit 9213 will be posted for 30 days.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
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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