Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908552
Report Date: 02/28/2018
Date Signed 02/28/2018 11:20:28 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:COOKS, DEBORAH FAMILY CHILD CAREFACILITY NUMBER:
153908552
ADMINISTRATOR:COOKS, DEBORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 246-8927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:14CENSUS: 2DATE:
02/28/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Deborah CooksTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Daniel Alvarez met with Licensee Deborah Cooks today for an unannounced Annual/Random inspection. A tour and inspection of the home, inside and outside, as shown on the facility sketch is provided. This is a two story house with child safety gate located at the bottom of the stairs making the second floor off-limits to day-care children. Background clearances were discussed and the LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPA observed safe toys, safe indoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items. Smoke and carbon monoxide detectors, fire extinguisher, and first aid kit are operable and in place. Rooms that are accessible to day care children are the entire first floor minus the garage and laundry room. Off-limits rooms are made inaccessible by child safety plastic spinning door knob(s) and child safety gate. CPR, first aid training and health and safety training are current expiring 04/08/2019. Licensee stated there are no firearms in this home, nor did LPA observed this item. There is a pool located on the premise the is fenced per title 22 regulations. Licensee does have one medium size dog that will be inaccessible to day-care children. Licensee is aware of child safety around pets and accepts responsibility for any actions taken by pets. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Required postings are correct. Day-care hours of operation are Monday through Friday from 6:00AM to 6:00PM and as arranged.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2018
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: COOKS, DEBORAH FAMILY CHILD CARE
FACILITY NUMBER: 153908552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2018
Section Cited
HSC
1597.622(a)(1)
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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 submit a copy of her complete immunization records to CCL by the given due date of 3/28/18.
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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: Daniel Q AlvarezTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2018
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: COOKS, DEBORAH FAMILY CHILD CARE
FACILITY NUMBER: 153908552
VISIT DATE: 02/28/2018
NARRATIVE
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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

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D).

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

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2018
LIC809 (FAS) - (06/04)
Page: 3 of 3