Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543907943
Report Date: 12/14/2018
Date Signed 12/14/2018 11:17:50 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:
(559) 667-5967
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY:14CENSUS: 7DATE:
12/14/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Olga VazquezTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced annual/random inspection. LPA met with Licensee Olga Vasquez. Also present was her assistant. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. No pets were observed during today's visit. There are no "bodies of water" or firearms in this home. LPA observed the licensee to have lots of toys and educational items for the children both indoors and outside. During viewing the backyard, the LPA observed the side exit gate not be latched and the adjacent fence that the gate latches to was loose. There were no poisons observed on the premises accessible to children. 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 and the number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee also maintains documentation of immunizations against pertussis, measles and influenza for herself and staff.

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. During the annual inspection Licensee stated they will NOT be providing Incidental Medical Services (IMS) at this time.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2018
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: VAZQUEZ, OLGA & JORGE FAMILY CHILD CARE
FACILITY NUMBER: 543907943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2018
Section Cited
CCR
102417(g)(6)
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Operation of a Family Child Care Home. Outdoor play area shall either be fenced or outdoor play areas shall be supervised by the licensee or caregiver. This requirement was not met as evidenced by the LPA observing
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Licensee shall tighten/repair the latch on the side gate so that it self latches/closes and secure the adjacent fence so that it is not loose.
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the side gate to be unlatched and the adjacent fence where the gate latches to be loose. This poses a possible risk to the health, safety or personal rights of children in care.
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Licensee will have this available for review by the due date of 12/17/18. A return visit will take place to clear 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: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2018
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: VAZQUEZ, OLGA & JORGE FAMILY CHILD CARE
FACILITY NUMBER: 543907943
VISIT DATE: 12/14/2018
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 on 5/22/20. 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. Days and hours of operation are Monday – Saturday; 5:00 AM – 5:00 PM.


Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page): 809 D


Exit interview was conducted with Licensee. LPA reviewed with licensee the Mandated Child Abuse Reporter Training, which was due by 3/31/2018. The licensee has completed the training but not her staff.
LPA informed licensee about the Community Care Licensing website: www.ccld.ca.gov. and discussed with licensee about the new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Updates that inform licensees of new legislation and regulations. Licensee was advised that forms and updated information may be obtained on the CCLD website and was also advised that it is her responsibility to stay current with regulations.

A copy of this report was provided and discussed along with appeal rights. 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: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2018
LIC809 (FAS) - (06/04)
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