Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203806650
Report Date: 10/19/2017
Date Signed 10/19/2017 04:30:06 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:URIBE, EVA FAMILY CHILD CAREFACILITY NUMBER:
203806650
ADMINISTRATOR:URIBE, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 664-0747
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 9DATE:
10/19/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Eva UribeTIME COMPLETED:
01:00 PM
NARRATIVE
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An unannounced Case Management inspection was made today, 10/19/17 by LPAs Patricia Musso and Kathie Campbell.

This Case Management inspection is made today due to deficiencies found by LPAs.
Upon LPAs arrival, licensee was caring for 9 children (3 infants and 6 children). LPAs explained, in depth, the requirements of capacity for a large and a small family child care home and informed licensee when she is by herself, even though she is licensed for a large family child care home, she needs to follow the capacity for a small family child care home. LPAs counseled licensee on how to handle when parents want to drop their child
off when licensee tells the parent that she can not accept the children because she is
at full capacity.
LPAs spoke to licensee about the requirements of having swings for the day care
children. Licensee understands that the swings that are at family child care homes need
to be secured to the ground for the safety of the children.
Title 22 Regulation deficiency noted on the following LIC809D.
During the exit interview, LPA reminded licensee to follow the requirements of AB633; Licensee needs to provide a copy of this report to each family and obtain a signed copy of LIC9224
for each child and maintain this copy in the children's file for the required 3 years
LPAs viewed the LIC9213 being posted and reminded licensee that it needs to be posted for 30 days.
Licensee is going to send a copy of her completed Facility Roster LIC9040 to LPA Musso, in the Fresno office by Wednesday Oct 25, 2017.
Licensee said her hours of operation are 5 days a week, 24 hrs a day.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
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: URIBE, EVA FAMILY CHILD CARE
FACILITY NUMBER: 203806650
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/19/2017
Section Cited
CCR
102416.5(a)(b)123
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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one whom care may
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During this visit 2 infants and 2 children were picked up and left.
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be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1)Four infants; or (2) Six children, no more than three of whom may be infants; Upon LPAs arrival, licensee was caring for 9 children (3 infants and 6 children) by herself.
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The above actions cleared this deficiency.
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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: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
LIC809 (FAS) - (06/04)
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