543911428-4-25-2022-04-CC-ROCA-CDTQXY-20220425123419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911428
Report Date: 04/25/2022
Date Signed: 04/25/2022 12:34:37 PM

Document Has Been Signed on 04/25/2022 12:34 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:	OLBERA, VICTORIA FAMILY CHILD CARE		FACILITY NUMBER:	543911428
ADMINISTRATOR:	OLBERA, VICTORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 202-6077
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	04/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Olbera, Victoria		TIME COMPLETED:	12:50 PM

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On 4/25/2022, Licensing Program Analysts (LPAs), Ruby Ocegueda and Priscilla Zamudio conducted an unannounced Annual Required Inspection and was met by Licensee, Victoria Olbera. Days and hours of operation are Monday through Friday 6:00 AM to 6:00 PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the kitchen, bathroom and living room, nook and one bedroom are used for care. Upon inspection of the previous pre-licensing report dated 4/2/2021 and per licensee interview today, the bedroom had not been previously approved for care. LPA reviewed the requirement to report any previously “off limit” rooms/areas to the Department so that it could be inspected before use. Today, LPA inspected the bedroom and approved it for care. The facility sketch was signed updated. All other rooms are off-limits and made inaccessible by use of door knob safety covers. 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. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 202-6077.

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care. LPA observed an infant sleeping with two stuffed animals today. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and LPA discussed the requirement to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Today LPA provided licensee with a sample sleep log. Infants can be visually observed through an open door if sleeping in a separate room. LPA reviewed Individual Infant Sleeping Plan with licensee which should be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Report continued to 809-C

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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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Document Has Been Signed on 04/25/2022 12:34 PM - It Cannot Be Edited

Created By: Ruby Ocegueda On 04/25/2022 at 11:43 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: OLBERA, VICTORIA FAMILY CHILD CARE	FACILITY NUMBER: 543911428
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above. Upon arrival, it was observed that one infant over the age of one year old was sleeping with two stuffed animals in the play yard. Licensee removed the items today and LPA discussed safe sleep requirements. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee was observed to remove the stuffed animals and stated she understood the regulation stated above. Licensee completed a written statement indicating understanding of the requirement as well. Deficiency cleared today.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. 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. LPAs Ocegueda and Zamudio reviewed children's files and observed that three out of five children's files were missing proof of required immunizations. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Licensee stated she would submit proof of required immunizations for children #2, #4, #5 to the Department by POC date 5/23/2022.

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:

Michael Duarte

LICENSING EVALUATOR NAME:

Ruby Ocegueda

LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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: OLBERA, VICTORIA FAMILY CHILD CARE	FACILITY NUMBER: 543911428
	VISIT DATE: 04/25/2022

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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. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. 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. Three out of five children’s files were missing immunizations. Licensee’s Mandated Reporter Training expired on January 2022. LPA reviewed the regulation to complete this training every two years. Licensee’s pediatric CPR/First Aid expires on 8/5/2023. 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: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

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