Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203904637
Report Date: 08/13/2019
Date Signed: 08/13/2019 02:40:26 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:MORENO, MARIA FAMILY CHILD CAREFACILITY NUMBER:
203904637
ADMINISTRATOR:MORENO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 479-8541
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 3DATE:
08/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria MorenoTIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Juvenal Moctezuma and Gheandip Badhesha conducted an unannounced Annual/Random inspection and met with Licensee, Maria Moreno. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. Upon arrival, licensee stated that she was caring for 3 children. Licensee was holding child #1. LPAs observed that Child #2 was sleeping in a playpen which was inside licensees family room. Child #3 was sleeping in the first bedroom.

Licensee stated that children have access to the Day care room, living room, kitchen/dining room, 1 bedroom for napping, a bathroom that's connected to the day-care room, and backyard. LPA observed plenty of age appropriate toys in the day-care room and observed that the house was clean and free of toxins. LPAs observed that the bedroom doors were all open and accessible 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. LPA observed a baby jumper/walker in the family room. Licensee stated that she doesn't use it and that's why its in the family room. LPA reminded licensee that she can not use the family room for napping if she's stating that its an inaccessible area for children in care. Licensee understood. The bathroom was found clean and free of toxins during the inspection.

The knives and medications are stored up high in a cabinet. The kitchen was observed to be clean and free of toxins. The chemicals and cleaning supplies are stored in the laundry room which is remained closed. The backyard has a fence that goes all around. LPAs observed a wooden play structure and other age appropriate toys. There was plenty of shade. Licensee has a small dog. Licensee understands responsibility of any action taken by pets involving day care children.

LPA spoke about the safe sleep regulations that will take affect this year (2019) 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. Licensee has a 2A10 BC fire extinguisher. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 02/22/2021.
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: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: MORENO, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203904637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
HSC
1596.841
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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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Licensee stated that she will complete her children's roster and submit a copy to CCL by no later than 08/23/2019.
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This roster shall be available to the licensing agency upon request. This requirement was not met as evidenced by licensee not having a completed Children's Roster. This poses a potential health safety risk to the children in care.
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Type B
08/30/2019
Section Cited
HSC
1597.622(a)(1)
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Employees or volunteers at family day care home; immunization requirements; records; exemptions- Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between...
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Licensee stated that she will submit proof of her immunization records to CCL by no later than 08/30/2019.
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This requirement was not met as evidenced by interviewing Licensee/file review and licensee not having proof that she is up to date with the immunization requirements per SB 792. Licensee is missing the MMR. This poses a potential 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: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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: MORENO, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203904637
VISIT DATE: 08/13/2019
NARRATIVE
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Licensee does not have proof that she has conducted fire/disaster drills within the last 6 months. The carbon monoxide and smoke detector were tested and found in working condition. Licensee stated that she did not have Child #1 and Child #2's file for LPAs to review. Licensee stated that she did not have a current children's roster. Licensee stated that she does not have any guns or ammunition in the home and LPAs did not observe any bodies of water during the inspection. Licensee does not have proof that she is up to date with the Measles immunization. Mandated Reporter Training AB 1207 was also discussed during todays inspection.

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 todays inspection, The following type B Deficiencies were observed and cited. Appeal rights were explained and provided to licensee.

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: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MORENO, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203904637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2019
Section Cited
CCR
102417(g)(10)
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Operation of a Family Child Care Home. A baby walker, is not permitted on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).A "baby walker" means any article described in paragraph (4) of subdivision (a) of Section
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Licensee stated that she does not use it for day-care children but will place it in an area that's inaccessible to day-care children. Licensee will write a plan of correction stating how this will not happen again and
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1500.86 of Part 1500 of Title 16 of the Code of Federal Regulations. This requirement was not met as evidenced by LPAs observing a baby jumper/walker in the family room. LPAs explained that these are not permitted in a day-care home. This poses a potential health/safety risk to children in care.
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submit a written copy to CCL by no later than 08/16/2019.
Type B
08/16/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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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:
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Licensee stated that she will conduct them and submit a copy to CCL by no later than 08/16/2019.
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Licensee failing to conduct fire & Disaster drills within 6 months. Licensee stated that its been more than 7 months since she last conducted a Fire drill. This poses a potential health and safety risk to the 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: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 3 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: MORENO, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203904637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
CCR
102421(a)(b)
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Child's Records. The licensee shall maintain, in each child’s record, the signed and dated notice form LIC 995A, Parents Rights Notice and a copy of the emergency information card required in Section 102417(g) (7). Based on licensee’s interview and missing file/records of child #1 and Child #2. Licensee
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Licensee stated that she will obtain all the children's forms that are required from licensing from the parents. Licensee will also write a Plan of correction stating how she will prevent this from happening again and submit a copy to CCL by 08/23/2019.
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failed to meet the regulation for children’s records. Child #1 and #2 are missing their complete files. Licensee states that she will provide the Licensing forms to the parents and create the children's files. This possess a Potential Health, Safety or Personal Rights 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: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
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