543908380-10-29-2024-57-CC-BGOZ-DAHPF7-20241029111615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543908380
Report Date: 10/29/2024
Date Signed: 10/29/2024 11:16:24 AM

Document Has Been Signed on 10/29/2024 11:16 AM - 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	CABRERA, GUADALUPE FAMILY CHILD CARE		FACILITY NUMBER:	543908380
ADMINISTRATOR/ DIRECTOR:	CABRERA, GUADALUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 562-2821
CITY:	LINDSAY	STATE: CA	ZIP CODE:	93247
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 4	DATE:	10/29/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Guadalupe Cabrera		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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On 10/29/2024 Licensing Program Analyst (LPA), Behatriz Gonzalez conducted an unannounced Annual Required Inspection and was met by licensee Guadalupe Cabrera. Also present was licenses assistant. Licensee is Spanish Speaking and Behatriz Gonzalez assisted with interpretation. Days and hours of operation are Monday to Saturday 6:00am – 6:00pm.

LPA toured the home inside and outside and a census was taken. LPA reviewed current facility sketch and confirmed that the dining, living room, bathroom and front yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by door locks. During todays inspection the kitchen was added as accessible.

There is no swimming pool or other bodies of water on the premises

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.

This is a single level home and there are no stairs. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 310-9271.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. During file review it was observed that there was missing 15 minute sleep logs and a missing 9227 safe sleep form. Licensee’s Mandated Reporter Training was completed on 1/08/2024. Licensee’s pediatric CPR/First Aid certification expires on 01/07/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Behatriz Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 10/29/2024 11:16 AM - It Cannot Be Edited

Created By: Behatriz Gonzalez On 10/29/2024 at 10:34 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: CABRERA, GUADALUPE FAMILY CHILD CARE	FACILITY NUMBER: 543908380
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. 102425(j)(1) - During File reviews licensee was not able to provide prrof that she was doing the 15 minute check. Sleep logs were not archived.
	POC Due Date: 11/05/2024
	Plan of Correction
1 2 3 4	Licensee send a picture of the completed 15 minutes sleep logs by POC date.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.Records - Type B: 102425(c) - During File review licensee was not able to provide 9227 form
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Licensee will send a picture of completed 9227 forms by end of POC date.

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:

Scott Herring

LICENSING EVALUATOR NAME:

Behatriz Gonzalez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CABRERA, GUADALUPE FAMILY CHILD CARE	FACILITY NUMBER: 543908380
	VISIT DATE: 10/29/2024

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LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

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 discussed 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-andresources/safe-sleep as an additional resource. 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.

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 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.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Behatriz Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CABRERA, GUADALUPE FAMILY CHILD CARE	FACILITY NUMBER: 543908380
	VISIT DATE: 10/29/2024

NARRATIVE

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Exit interview conducted and report was reviewed with licensee Guadalupe Cabrera. 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, of the California Code of Regulations, the following deficiencies are 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: Scott Herring
LICENSING EVALUATOR NAME: Behatriz Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC809 (FAS) - (06/04)

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