Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153903235
Report Date: 01/22/2016
Date Signed: 01/22/2016 02:49:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:TINOCO, TRINDAD FAMILY CHILD CAREFACILITY NUMBER:
153903235
ADMINISTRATOR:TINOCO, TRINIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 854-1723
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 1DATE:
01/22/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Trinidad Tinoco, LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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(3) LPA Pete Espinoza made an unannounced Annual/Random visit. LPA met with Trinidad Tinoco, Licensee, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this facility. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked There is no fireplace. Fire extinguishers and smoke detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. The home provides safe toys, play equipment, and materials. Facility has one or more functioning carbon monoxide detectors that meet the statutory requirements. The licensee is present in the home and ensures that children in care are supervised at all times. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. Any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home.

Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2016
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: TINOCO, TRINDAD FAMILY CHILD CARE
FACILITY NUMBER: 153903235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2016
Section Cited
102416(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. Licensee was unable to provide proof of current EMSA-certified Pediatric First Aid/CPR training.
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Licensee will send copy of current EMSA-certified Pediatric First Aid/CPR cards to Fresno Regional Office by 02/22/2016.
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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 deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2016
LIC809 (FAS) - (06/04)
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