Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503605760
Report Date: 05/17/2019
Date Signed: 05/17/2019 03:23:18 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:BELTRAN, EVAFACILITY NUMBER:
503605760
ADMINISTRATOR:BELTRAN, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 284-0045
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:14CENSUS: 0DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Eva BeltranTIME COMPLETED:
03:45 PM
NARRATIVE
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An annual visit #3 is being conducted by LPA Claudia Henley. I was met by licensee Ms. Beltran and her spouse. There were no day care children present today. A tour of the home, inside and outside, as shown on the facility sketch is provided. This home is a two story home, and children do not have access to the second story. There was an installed child proof gate at the foot of the stairs. There are no firearms in this home, per licensee. No bodies of water on the premises. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. Fire/disaster drill conducted January 2019. Fireplace is not used during day care. There is a working fire extinguisher, a smoke detector, carbon monoxide detector and there is adequate heating and ventilation for safety and comfort. 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. There are two storage sheds that are locked. No pets on the premises. 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. No medication is given to day care children. One child's file was reviewed. Licensee current on immunization record. Licensee stated that she did not complete the Online Child Abuse Mandated Reporter Training. The child care hours/days of operation are: Monday through Friday, 7:00 a.m. to 5:30 p.m.

The following is cited per Title 22 Regulations (see page 2). Appeal Rights left with licensee. Site Visit Notice posted on the parent board.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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: BELTRAN, EVA
FACILITY NUMBER: 503605760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
HSC
1596.8662
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Health & Safety Code - Section 1596.8662: Requires all licensed providers and employees to complete training on their mandated reporter duties &
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Licensee to complete the online training by 6/17/19 and send a copy of the certificate to CCL.
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to renew every two years. This requirement was not met as evidenced by: Licensee stated she did not complete the online training.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
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