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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203908693
Report Date: 08/30/2021
Date Signed: 08/30/2021 05:41:41 PM

Document Has Been Signed on 08/30/2021 05:41 PM - It Cannot Be Edited

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:CALDERON, MARGARITA FAMILY CHILD CAREFACILITY NUMBER:
203908693
ADMINISTRATOR:CALDERON, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 718-5750
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Margarita CalderonTIME COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Brannon and Iglesias. conducted a case management inspection. During today's inspection, LPA Brannon heard a female voice coming from a room that is inaccessible to children in care. LPA questioned licensee and was informed that adult #1 moved into the home yesterday. LPA questioned adult #1 and was informed that adult #1 spent the night. LPA informed adult #1 and licensee that until the fingerprint clearance is received, adult #1 cannot reside in the home. LPA informed licensee that adult #1 cannot return until fingerprint clearance has been received.

Upon arriving at the facility, LPAs asked if there were only four children. LPA Brannon counted the children. Per licensee, there was only one infant and three children ages 2 to 3 years old. During the inspection, LPAs heard a baby crying in the back of the house with the door closed. LPA Iglesias went to the closed bedroom and found a crying 11 month old infant in a car seat. LPAs arrived at facility at approximately 2:30 PM. LPA Iglesias found the infant in a car seat at 2:57 PM.

Upon arriving at facility, LPAs observed licensee and spouse/assistant were not wearing face masks. As assistant was picking up and dropping off the school age children, LPAs observed that the school age children were not wearing their face masks as required by California Public Health Department/Centers for Disease Control and Prevention. At this time, children do not have access to the COVID vaccine. This places children in a vulnerable position. LPA Iglesias reviewed with licensee the importance of mitigating the spread of COVID.

CONTINUED ON FOLLOWING PAGE
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 08/30/2021 05:41 PM - It Cannot Be Edited


Created By: Cynthia Brannon On 08/30/2021 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CALDERON, MARGARITA FAMILY CHILD CARE
FACILITY NUMBER: 203908693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2021
Section Cited
CCR
102370(d)(2)

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Criminal Clearance Record. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility. This requirement was not meet as evidenced by LPAs observation of adult #1 in the home. Licensee informed LPAs that adult #1
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Licensee and adult #1 were informed that adult #1 cannot return to the home until fingerprinted cleared. Licensee will provide a written statement that adult #1 will be fingerprint cleared before being permitted to move into the home.
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moved into the home, yesterday. This is an immediate personal rights, health and safety to the children in care. A civil penalty of $100.00 has been assessed.
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Type A
08/30/2021
Section Cited
CCR102425(h)

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Infant Safe Sleep. Car seats shall only be used for transportation purposes and shall not be used for sleeping. If the infant is sleeping in a separate room from where the provider is stationed, the door to the room where the infant is sleeping shall remain open at all times. This requirement was not meet as evidenced by LPAs observation of an
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During today's inspection, when LPAs oberved the infant in the car seat crying, behind closed doors, licensee immediately removed the infant from the car. Per licensee, she will provide a written statement that she will not leave sleeping child in a car seat, will keep the car seat outside, will not leave a sleeping infant/child alone in a room.
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infant crying behind closed door and in a car seat. Per licensee, infant was asleep upon arriving at facility. LPAs arrived at facilty at 2:30 PM and heard a crying infant in the back room at 2:57 PM. The infant was left alone in the back room for an estimated time of 27 minutes in a car seat. This is an immediate personal rights, health and safety to the children in care.
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This documentation will be sent to the Fresno Community Care Licensing office by 9/7/21.
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:Michael Duarte
LICENSING EVALUATOR NAME:Cynthia Brannon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2021


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Document Has Been Signed on 08/30/2021 05:41 PM - It Cannot Be Edited


Created By: Cynthia Brannon On 08/30/2021 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CALDERON, MARGARITA FAMILY CHILD CARE
FACILITY NUMBER: 203908693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/07/2021
Section Cited
CCR
102425(c)

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Infant Safe Sleep. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. Documentation shall be maintained in the infant’s file and be available to the Department for review.
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Per licensee, she will provide copy of infant #1 and infant #2 file to Community Care Licensing office before 9/7/21.
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Documentation shall include the following: Date, Infant’s name, Time of each 15-minute check. This requirement was not meet as evidenced by licensee's failure to provide files for infants #1 and #2, nor a completed LIC 9227. This is a potential personal rights, health and safety risk to children in care.
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Type B
08/30/2021
Section Cited
CCR102423(a)(2)

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Personal Rights.To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by LPAs observation of licensee and spouse were not wearing their face masks. LPAs observed that school age children were not wearing face masks while inside facility.
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Licensee immediately put on the face mask and gave her spouse a face mask to wear. Licensee will provide written documentation of her protocol/policy
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This is a potential personal rights, health and safety 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:Michael Duarte
LICENSING EVALUATOR NAME:Cynthia Brannon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2021


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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: CALDERON, MARGARITA FAMILY CHILD CARE
FACILITY NUMBER: 203908693
VISIT DATE: 08/30/2021
NARRATIVE
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Type A deficiencies were cited. 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. 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, these deficiencies are to be cited. Exit interview conducted with licensee, Margarita Calderon. Plan Of Correction/Appeal Rights were given and discussed. A Notice of Site Visit was posted on parent board in the presence of LPA Brannon.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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