Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203804438
Report Date: 02/13/2020
Date Signed: 02/13/2020 05:12:17 PM

COMPREHENSIVE INSPECTION
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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
203804438
ADMINISTRATOR:RODRIGUEZ, GABRIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 661-8829
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: DATE:
02/13/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Gabriela RodriguezTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random inspection and met with Assistants, Yolanda and Elena. Assistant, Yolanda stated that licensee was out picking up children from school and would return shortly. LPA explained the reason of the inspection and Yolanda invited LPA inside the home while licensee returned. LPA observed both assistants caring for 6 children. Approximately 15 minutes later, Licensee arrived with 2 additional children. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. Licensee stated that she was going to go pick up more children from school so she allowed LPA to stay with 2 assistants in the house who were caring for 7 children since 1 child was picked up during the inspection.

Licensee stated that children have access to the living room, kitchen/dining room area, one bathroom, and backyard. LPA observed plenty of age appropriate toys in the living room. The inside of the home was observed clean and free of toxins during todays inspection. LPA reminded licensee to make sure the bedrooms are remained closed and locked since she's stating that they are inaccessible to children in care. Licensee was reminded about having Off limit areas closed and locked and the types of toys permitted during her day-care hours. Licensee understood.

The knives and medications/vitamins are stored in a high cabinet that's inaccessible to children in care. All the licensees kitchen drawers and cabinets have a plastic latch in place. The cleaning supplies are stored in licensees garage which is remained closed and locked during day-care hours.

LPA spoke about the safe sleep regulations with licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure. The bathroom was found clean and free of toxins during the inspection.

Report continued onto LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 203804438
VISIT DATE: 02/13/2020
NARRATIVE
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The backyard has a fence that goes all around and LPA observed plenty of age appropriate toys. LPA also observed a propane gas tank attached to a grill, helium tanks, 2 buckets of paint that contained small amounts of water inside. LPA reminded licensee that buckets and anything else that can accumulate water need to be stored in areas that are inaccessible to children because they can be considered bodies of water. Licensee understood and dumped the water and put away the buckets. LPA also observed licensees gardening tools like shovels and rakes along with metal bed frames.

Licensee has a 2A10 BC fire extinguisher that was purchased in November 2019. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees and assistants CPR/First Aid certificates are good until 05/25/2021. The last time Licensee conducted the fire/emergency drills with children was on 06/24/2019. The carbon monoxide and smoke detector were tested and found in working condition. A sampling of children's files were reviewed along with the children's roster and everything was completed and up to date. Licensee stated that there are no guns or ammunition in the home and LPA did not observe any bodies of water during the inspection. Licensee and her assistants are current with the immunization requirements per SB 792. Mandated Reporter Training AB 1207 was discussed today during the inspection.

During todays inspection, Licensee stated that her mother in law- Esther Rangel was present in the home and is currently residing in the home without a prior fingerprint clearance. A civil penalty is assessed of $100.00 for failure to obtain a criminal record clearance for Licensee's Mother in law who resides in the home.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

During today's inspection, The following Type A and Type B Deficiencies were observed and cited. Appeal rights were explained and provided to licensee, Gabriela Rodriguez.

Report Continued onto LIC 809-C

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 203804438
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2020
Section Cited

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as
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evidenced by LPA observing gardening tools like shovels, rakes, propane gas tank, helium tanks, old cans of paint, metal bed frames, 2 buckets of paint with water inside in the backyard. This poses an immediate health/safety risk to children in care.
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Licensee will write a plan of correction stating how this will not happen and submit written proof to CCL by no later than 02/17/2019.
Type B
02/17/2020
Section Cited

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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. This requirement was not met as evidenced by interview. Licensee informed LPA that she has not completed an actual fire drill and has not
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documented required fire drills with the date and time. The last time that she had documented was on 06/24/2019. This poses a potential health, safety, or personal rights risk to the children in care.
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Licensee will send a copy of the above mentioned fire drill documentation to LPA by 02/17/2020.
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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 203804438
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2020
Section Cited

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Criminal Record Clearance- All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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This requirement was not met as evidenced by Licensee failing to get her Mother in law, Esther Rangel livescanned before residing in her home. This poses an immediate health/safety risk to 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 203804438
VISIT DATE: 02/13/2020
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Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809, two (2) LIC 809 C, and LIC 809 D.

This report was translated in Spanish by LPA Moctezuma.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
LIC809 (FAS) - (06/04)
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