Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543907943
Report Date: 03/16/2017
Date Signed 03/16/2017 10:55:02 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:VAZQUEZ, OLGA & JORGE FAMILY CHILD CAREFACILITY NUMBER:
543907943
ADMINISTRATOR:VAZQUEZ, OLGA & JORGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5597409608
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY:14CENSUS: 0DATE:
03/16/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Olga VazquezTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPAs) Robert Gutierrez and Arnold Cortez conducted an unannounced annual/random visit. LPAs met with Licensee Olga Vazquez. LPAs conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. There is a dog that is inaccessible to children in care. Licensee is aware of the safety of children with children in care. There are no "bodies of water" on the premises. Firearms and ammunition are properly stored per title 22 regulations. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone (559) 740-9608 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 is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunization's for the children. 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 6/28/2018. 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.

SUPERVISOR'S NAME: Rebecca VarelaTELEPHONE: (559) 243-8106
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: VAZQUEZ, OLGA & JORGE FAMILY CHILD CARE
FACILITY NUMBER: 543907943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2017
Section Cited
H.S 1597.622
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The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home. During the visit the licensee was unable to provide proof of measles and pertussis immunization's for her assistant. This poses a potential health and safety risk to the children in care.
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Licensee agrees to send proof of the required immunization's: Measles and Pertussis on or before 4/14/2017.
Type B
04/14/2017
Section Cited
102417(g)
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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. While inspecting the backyard play area, LPA's observed a swing set that was not anchored to the ground, the side gate latch was broken off from the door and, a hole in the fence.
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Licensee will send photos of fixing the hole in the fence/side gate door and, either anchoring or throwing away the swing set.
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The door is heavy enough to where children can not open the gate. The neighbors have a dog next door where children can be bitten if they were to put there hands into the fence hole. However, no children were outside, It is due to these reasons this poses as a potential risk to children in care.
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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) 243-8106
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC809 (FAS) - (06/04)
Page: 3 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: VAZQUEZ, OLGA & JORGE FAMILY CHILD CARE
FACILITY NUMBER: 543907943
VISIT DATE: 03/16/2017
NARRATIVE
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LPA discussed 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.htm

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found


(see next page):

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) 243-8106
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3