Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503605760
Report Date: 11/12/2015
Date Signed: 11/12/2015 01:07:11 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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:BELTRAN, EVAFACILITY NUMBER:
503605760
ADMINISTRATOR:BELTRAN, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 545-2127
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:14CENSUS: 7DATE:
11/12/2015
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Eva BeltranTIME COMPLETED:
01:50 PM
NARRATIVE
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An annual visit #2 is being conducted by LPA Claudia Henley. I was met by licensee Ms. Beltran and her adult assistant. There were seven children present today. A tour of the home, inside and outside, as shown on the facility sketch is provided. Staff and Children were spoken to during visit. This home is a two story home, and children do not have access to the second story. At the time of LPA arrival, the child proof gate at the foot of the stairs was not installed and an infant child was sitting inside of a exeosaucer/walker. LPA informed licensee that the gate must be installed at all times when children under the age of 5 years are present and that exeosaucers/walkers are not allowed in day care. Licensee installed the child proof gate back and removed the child out of the exeosaucers/walker and the exeosaucer/walker was removed at the time of the visit. There are no firearms in this home, per licensee. In addition, during LPA inspection of the back yard, licensee had installed a fish pond which was full of water. Licensee could not recall when this water pond was installed. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. Fire/disaster drill conducted in August of 2015. Fireplace is not used during day care. There is a working fire extinguisher, a smoke detector and there is adequate heating and ventilation for safety and comfort. Licensee was not aware that a carbon monoxide detector was required to be installed in the home. Safe toys and play equipment are observed. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the fenced play area. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. 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. Pediatric CPR & Pediatric First/Aid is current on licensee and assistant until 11/2017. Licensee did not have all of the necessary licensing documents in the children's files or some files were missing. The child care hours/days of operation are: Monday through Friday, 7:00 a.m. to 5:30 p.m.
Licensee did not have a carbon monoxide detector installed at the time of visit. Licensee to purchase and install the unit and send receipt and photograph showing installation to CCL by 11/26/15.


SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2015
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 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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: BELTRAN, EVA
FACILITY NUMBER: 503605760
VISIT DATE: 11/12/2015
NARRATIVE
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Licensee stated today that she does not give any medication other than occasional over-the-counter medication for the day care children. Licensee was advised that in the future if she decides to give any medication other than over-the-counter, she will need to contact our office regarding the Incidential Medical Services (IMS) which she will need to submit to the department for approval.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see page 3 & 4):

Site Visit Notice posted on the parent board. Exit interview was conducted.

The licensee shall post and provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of this report must be given to each enrolled child's parent(s). The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. The licensee must implement the new procedure immediately, by having all parents of enrolled children sign the Acknowledgement of Receipt of Licensing Reports and must retain a copy in each child's file.




SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2015
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: BELTRAN, EVA
FACILITY NUMBER: 503605760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2015
Section Cited
102417(g)(10)
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102417(g)(10) 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). There was an exeosaucer/walker with an infant child inside of it during today's visit.
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Licensee removed the child from the equipment and took the equipment into the garage. She stated she would give this back to the child's parent. Licensee was reminded that they are not allowed for day care use and children cannot have access to these type of equipment. Licensee to send plan of correction/action to CCL by 11/26/15
Type A
11/12/2015
Section Cited
102417(g)(5)
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102417(g)(5) Operation of a Family Child Care Home. All pools, spas, hot tubs, fish ponds, or similar bodies of water shall be covered or fenced as specified to be inaccessible to children. LPA observed in the backyard a fish koi pond full of fish and water. This pond is accessible to the children and it was not fenced or covered per Title 22 Regulation.
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Licensee stated that her husband is the only person that knows how to drain the pond and he will not be home until late tonight. Licensee was advised that once the pond is drained that she will need to notify by telephone and send a photograph that is stamped with the date and time showing that the pond has been drained of water.
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This is an immediate health and safety risk to children. Must be corrected immediately.
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Therefore, an immediate $150 zero tolerance civil penalty was issued today, followed by $150 per day per violation will be assessed until corrected
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Licensee will need to provide 100% visual supervision and all doors that lead out to the pond area remain locked until the pond is drained. Licensee was advised that the $150.00 per day civil penalty will continue until the correction is submitted to licensing.
Type A
11/26/2015
Section Cited
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102417(g)(3) Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded.
At the time of LPA arrival, the child proof gate at the foot of the stairs was not installed. Children had access to the second story. Licensee was previously cited for same deficiency on 6/27/13
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Licensee installed the childproof gate at the foot of the stairs at the time of the visit. Licensee to send the plan of correction/action to CCL by ll/26/15
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: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2015
LIC809 (FAS) - (06/04)
Page: 2 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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: BELTRAN, EVA
FACILITY NUMBER: 503605760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2015
Section Cited
102418(g)
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102418(g) Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. During children's record review, Child #5 was missing immunizations. Child #1 & Child #2 did not have a file for review. Licensee stated she could not locate Child #1 & #2 files

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Licensee to obtain the immunizations on Child #5 and submit to the department copies of Child #1 & Child #2 records. Send to CCL by ll/26/15
Type B
11/26/2015
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children. Licensee did not have a current updated LIC 9040 (Child Care Facility Roster).
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Licensee stated that her roster is old and she has not updated the information for a long period of time. Licensee to send an updated roster to CCL by 11/26/15.
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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: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2015
LIC809 (FAS) - (06/04)
Page: 3 of 4