Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203806650
Report Date: 12/01/2017
Date Signed 12/01/2017 02:33:37 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: 6DATE:
12/01/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Licensee, Eva UribeTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst, Kathie Campbell conducted a Case Management inspection. Met with licensee, Eva Uribe. There were 6 children present. Licensee is licensed for a capacity of 14. She stated she doesn't have a qualified assistant to help in her day care during the hours of 7:00 AM and 5:00 PM. A tour of the home was made with the licensee. Off limit rooms were not made inaccessible to children. LPA observed there was no toilet seat on the toilet in the children's bathroom. Toiletries cleaning products and razors were accessible under the sink and in the shower. LPA observed a trampoline in the back yard that was is disrepair with no padding in areas and that the licensee was unable to zip. LPA observed shovels propped against the fence, a dead bird and dog feces on the ground. LPA observed the licensee does not have proof of immunizations during this visit.Document Link Icon
"Upon receipt of a type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at this time and to parents/guardians of children newly enrolled at the facility during the next 12 months." The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. A completed signed copy of the LIC 9224 will be placed in each child's file.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiencies are being cited on the attached LIC 9099D.

An exit interview conducted with licensee, Eva Uribe. The licensee, Eva Uribe was provided a copy of appeal rights (LIC9058 12/15) and her signature on this form acknowledges receipt of this form. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Kathie CampbellTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2017
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: 12/01/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2017
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. LPA observed Kaboom cleaner, razors and toiletries in the children's bathroom. LPA observed a child go to the bathroom by herself. This is an immediate risk to children in care.
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Licensee removed the harmful items immediately and stated she will have her daughter use a basket for her toiletries and will keep the cleaning products in her laundry room.
Type A
12/01/2017
Section Cited
CCR
102417(b)
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Operation of a Family Child Care Home. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. LPA observed the toilet seat was off of the toilet and the licensee saw letting children sit on the rim of the toilet. LPA observed the toilet had urine on the rim and the inside of the toilet was not clean. Also there was no soap or towels to clean hands. This unsanitary and is an immediate risk to child in care.
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Licensee called someone and they installed the toilet seat. She cleaned the toilet today and put soap and towels in the bathroom and will make sure the bathroom has hand soap and towels.
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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: Kathie CampbellTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2017
LIC809 (FAS) - (06/04)
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