Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203904885
Report Date: 03/21/2018
Date Signed: 03/21/2018 04:29:31 PM

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:BECERRA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
203904885
ADMINISTRATOR:BECERRA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-3809
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:14CENSUS: 5DATE:
03/21/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Guadalupe BecerraTIME COMPLETED:
04:40 PM
NARRATIVE
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An unannounced Annual/Random inspection was conducted today by Licensing Program Analyst (LPA), Norma Lomeli. Present during the visit was licensee and five day-care children. Licensee and her adult grandson reside in the home. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance (or exemption).
  • The licensee has current pediatric CPR and First Aid that expire on 10/14/19. Preventative Health Practice was completed and confirmed at pre-licensing visit.
  • LPA observed children's cubbies, safe toys, an infant swing, a flat screen television and a couch for the children.
  • The licensee ensures that children in care are supervised at all times.
  • This is a two story home where there is a child safety gate on the stairs making the upstairs inaccessible to the children.
  • Licensee states there are no firearms or ammunition in the home.
  • Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children.
  • There is a fireplace in the living room that licensee states it is never used.
  • Facility has 2A10BC fire extinguisher and smoke detectors that meet State Fire Marshall standards. Facility has a working carbon monoxide detector that meets the statutory requirements.
  • No bodies of water observed in or on the premises.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)331-0781
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
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: BECERRA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 203904885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2018
Section Cited
CCR
102417(b)
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OPERATION OF A FAMILY CHILD CARE HOME. The home shall be kept clean and
orderly. The living room carpet and day care room rug have several stains and need to be shampooed and cleaned. Day care children use this area of the home to play and nap.
This poses a potential risk to the health and safety of the children in care.
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Licensee agrees to have the living room carpet and day care room rug cleaned and stains removed. Licensee agrees to send proof to Fresno CCL office by 04/04/18.
Type B
04/04/2018
Section Cited
CCR
102417(g)(9)(A)
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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. Licensee could not find fire disaster drill during visit. This poses a potential risk to the health and safety of the children in care.
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Licensee agrees to conduct, document and send proof of fire and disaster drill on or before 04/04/18. Licensee agrees to conduct a fire and disaster drill once every six months.
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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: Norma LomeliTELEPHONE: (559)331-0781
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: BECERRA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 203904885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2018
Section Cited
HSC
1597.622(c)
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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 August 1 and December 1 of each year.
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Licensee agrees to send proof to Fresno CCL office of the required immunizations: Measles Pertussis and Influenza on or before 04/04/2018.
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During visit, licensee could not provide proof of immunizations: Influenza, Pertussis, Measles. This poses a potential risk to the health and safety of children in care.
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Type B
04/04/2018
Section Cited
CCR
102421(b)
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CHILDS RECORDS. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7). Licensee had a total of five children under her care during visit. Licensee was not able to provide LPA with children's files. This poses a potential risk to the health and safety of the children in care.
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Licensee agrees to send proof of the children's files who are currently enrolled to Fresno CCL office on or before 04/04/18.
Type B
04/04/2018
Section Cited
CCR
102417(g)(8)
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OPERATION OF A FAMILY CHILD CARE HOME. All homes shall have a current roster of the children. During the visit, LPA observed five children in care but the licensee was unable to provide LPA with a current children's roster. This poses a potential risk to the health and safety of the children in care.
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Licensee agrees to provide Fresno CCL office with a current Child Care Facility Roster on or before 04/04/18.
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: Norma LomeliTELEPHONE: (559)331-0781
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
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: BECERRA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 203904885
VISIT DATE: 03/21/2018
NARRATIVE
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  • Licensee states she maintains licensed capacity at all times.
  • Licensee does transport children on her personal vehicle. Applicant understands that she must have proper restraints and/or car seats for all the children under her care.
  • SB 792 Implementation for required immunizations effective September 1, 2016 was discussed.
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a).
  • Licensee states her home is smoke free.
  • 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

Hours or operation are Monday through Friday from 6:00AM to 6:00PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee understands children may not be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)331-0781
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
LIC809 (FAS) - (06/04)
Page: 2 of 4