Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153906054
Report Date: 06/22/2016
Date Signed 06/22/2016 02:17:08 PM

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:PLUMLEY, TERESA FAMILY CHILD CAREFACILITY NUMBER:
153906054
ADMINISTRATOR:PLUMLEY, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 663-0175
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:14CENSUS: 6DATE:
06/22/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Teresa Plumley, LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
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(3) LPA Pete Espinoza made an unannounced Annual/Random visit. LPA met with Teresa Plumley, Licensee, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this facility. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked. Fireplace is inaccessible to children. Fire extinguishers and smoke detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. The home provides safe toys, play equipment, and materials. Facility has one or more functioning carbon monoxide detectors that meet the statutory requirements. The licensee is present in the home and ensures that children in care are supervised at all times. Children are not 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. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. Any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2016
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: PLUMLEY, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153906054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2016
Section Cited
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). Children's files did NOT contain completed Consent for Emergency Treatment (LIC627). This is a potential safety hazard for children.
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Licensee will provide completed Consent for Emergency Treatment (LIC627) in all children's files by 07/06/2016.

A return visit will be required to verify Consent for Emergency Treatment (LIC627) are completed accordingly.
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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: Diana deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: PLUMLEY, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153906054
VISIT DATE: 06/22/2016
NARRATIVE
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The licensee and other personnel as specified have completed training on preventive health practices including pediatric CPR and First Aid; Expires: 08/16/2016.

Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.

LPA informed Licensee of requirement regarding a Plan for Incidental Medical Services - IMS, effective July 1, 2015. The facility provides Incidental Medical Services – IMS. Currently there are no children requiring Incidental Medical Services. Licensee shall submit a Plan for Providing Incidental Medical Services to Fresno Regional Offices within 30 days from today’s date.

The following is cited per Title 22 Div. 12 of the CCR: (see page 2) Copy of appeal Rights left with center representative/licensee.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3