Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223802118
Report Date: 12/05/2016
Date Signed 12/05/2016 11:20:45 AM

COMPREHENSIVE INSPECTION
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:CAREY'S DAY CAREFACILITY NUMBER:
223802118
ADMINISTRATOR:CAREY, VALERIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 966-8323
CITY:MARIPOSASTATE: CAZIP CODE:
95338
CAPACITY:14CENSUS: 9DATE:
12/05/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Valerie CareyTIME COMPLETED:
12:00 PM
NARRATIVE
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(3) Licensing Program Analyst (LPA) Catherine Chambers conducted an unannounced annual/random visit. LPA met with Licensee Valerie Carey. Also present were 9 children in care. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Staff and Children were spoken to during this visit. No pets observed at today's visit. There are no "bodies of water" or firearms in this home. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. There is a pellet stove that is not used during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. Stairs must be barricaded when children under age 5 years old are present. 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 must be maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. LPA discussed new Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements.
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.http

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SUPERVISOR'S NAME: Rebecca VarelaTELEPHONE: (559) 650-7856
LICENSING EVALUATOR NAME: Catherine ChambersTELEPHONE: (559) 341-4450
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2016
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CAREY'S DAY CARE
FACILITY NUMBER: 223802118
VISIT DATE: 12/05/2016
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 and expire January, 2017. 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 advance notice. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. LPA & licensee also discussed the Community Care Licensing Division's website, www.ccld.ca.gov. It is recommended that licensee's check the website often as the State of CA no longer mails updates to each licensee. LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) that allows licensee's to sign up and receive updates that are emailed directly. The website also has current information for providers including the Quarterly Update that informs licensee's of new legislation and regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.


(see next page):

A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements, a copy of LIC 9224, and appeal rights were given to licensee.
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: Rebecca VarelaTELEPHONE: (559) 650-7856
LICENSING EVALUATOR NAME: Catherine ChambersTELEPHONE: (559) 341-4450
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2016
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: CAREY'S DAY CARE
FACILITY NUMBER: 223802118
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2016
Section Cited
102416.5(a)(e)
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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. (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee shall ensure that she maintains the correct capacity and ratio when there is no assistant present. Licensee understands that her ratio reverts to a capacity of 8 when there is no assistant present.
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At the time of the inspection, there were 9 children in care including 2 infants, 6 preschool, and 1 school age child. Operating over capacity poses a risk to children in care.
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Type A
12/06/2016
Section Cited
102417(g)(3)
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102417(g)(3) Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded. When LPA arrived, the stairs were not barricaded and children under 5 were allowed access. This poses a risk to children in care.
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Licensee shall place a barricade at the bottom and top of the stairs preventing access to children under 5 years of age. Licensee shall submit proof of this correction by December 6, 2016.
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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: Rebecca VarelaTELEPHONE: (559) 650-7856
LICENSING EVALUATOR NAME: Catherine ChambersTELEPHONE: (559) 341-4450
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2016
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: CAREY'S DAY CARE
FACILITY NUMBER: 223802118
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2017
Section Cited
HS 1597.622(c)
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The requirement of measles, pertussis and influenza immunization became effective September 1, 2016. The licensee was not aware of this requirement. LPA and licensee discussed it is the licensee’s responsibility to keep abreast of regulations, by visiting the website: www.ccld.ca.gov
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Licensee will obtain proof of completion, will keep proof in file at the facility and will send copy to CCL by January 5, 2017.
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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: Rebecca VarelaTELEPHONE: (559) 650-7856
LICENSING EVALUATOR NAME: Catherine ChambersTELEPHONE: (559) 341-4450
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4