Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503908292
Report Date: 10/07/2019
Date Signed: 10/09/2019 11:50:12 AM

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:MARTINEZ, DIANNA FAMILY CHILD CAREFACILITY NUMBER:
503908292
ADMINISTRATOR:MARTINEZ, DIANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 380-4059
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:14CENSUS: 3DATE:
10/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Dianna MartinezTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Candis Rodriguez and Diana Martinez conducted an unannounced annual inspection. LPAs were greeted by Licensee Dianna Martinez who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present was one (1) assistant, Martha Mendoza. Present during today’s inspection were three (3) children. The areas of the home that are accessible to the day care children are the living room, kitchen, dining room, family room, bedroom #1, bedroom #2, bedroom #3, and the hallway bathroom. “Off-limits” rooms are made inaccessible by lock. Two pets were observed during today’s visit; licensee is aware of the safety of children around animals. There are no "bodies of water" in this home. Licensee stated there are no firearms in this home. No poisons were observed on the premises during today’s inspection. Fireplace is inaccessible to children by protective glass. There is a working fire extinguisher. The smoke detector and carbon monoxide indicator were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the unfenced play area. Capacity as specified on the license is being maintained.

LPAs observed cleaning compounds such as Windex, Easy Off, Comet, Lysol spray, and Weiman Stainless Steel polish in a cabinet underneath the kitchen sink. The cabinet underneath the sink had worn out safety latches which were observed not to be functioning, allowing the cleaning compounds to be accessible to children in care.

Upon review of facility files, LPAs observed Child #1’s file was missing immunization documentation. LPAs also observed Child #2’s file was missing all required licensing forms, including emergency contact information. Licensee stated Child #2 started coming to her day care today, and the parent will complete the forms when Child #2 is picked up today. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for herself, however, Licensee's assistant who is present today does not have immunizations on file. (Continued on LIC809C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
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 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: MARTINEZ, DIANNA FAMILY CHILD CARE
FACILITY NUMBER: 503908292
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee
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or registrant to consent to emergency medical care. This requirement was not met as evidenced by LPAs observation of missing emergency information for Child #2. This poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
11/04/2019
Section Cited

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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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This requirement was not met as evidenced by LPAs observation of Licensee's assistant not having any documentation of immunization in her file. This poses a potential risk to the health, safety, and personal rights of 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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MARTINEZ, DIANNA FAMILY CHILD CARE
FACILITY NUMBER: 503908292
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by LPAs observation of cleaning compounds under the kitchen
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sink accessible to children in care. This poses a potential risk to the health, safety, and personal rights of 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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2019
LIC809 (FAS) - (06/04)
Page: 3 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: MARTINEZ, DIANNA FAMILY CHILD CARE
FACILITY NUMBER: 503908292
VISIT DATE: 10/07/2019
NARRATIVE
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Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles. 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. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Pediatric CPR/First Aid are current expiring on 10/14/2020. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Friday; 6:00 AM – 6:00 PM.

LPAs discussed Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. 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.



LPAs & licensee discussed the Community Care Licensing website. LPAs and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN. LPA thoroughly discussed safe sleep practices and left a copy of A Child Care Provider’s Guide to Safe Sleep.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page, LIC809-D).
**On this date, signatures were not able to be obtained, and the report was unable to be printed due to LPAs computer going into a consistency check. LPA returned on 10/09/2019 to obtain signatures and leave copy of report with appeal rights.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4