<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909162
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:04:09 PM

Document Has Been Signed on 09/21/2023 01:04 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PULIDO, MARGARITA & ADOLFO FAMILY CHILD CAREFACILITY NUMBER:
243909162
ADMINISTRATOR:PULIDO, MARGARITA & ADOLFOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 658-2687
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
09/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margarita Pulido-LicenseeTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/21/2023, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensees Margarita and Adolfo Pulido. Also present was licensees’ adult son. Licensees is Spanish Speaking and licensees’ adult son translate as well as licensee Margarita communicate English with LPA. Days and hours of operation are Monday through Friday, from 5:00 AM-7:00 PM and as arranged by parents. The home has a working telephone service and LPA confirmed the phone number is (209) 658-2687. Licensees stated that they provided breakfast, lunch, and snack for the daycare children throughout the day.

LPA toured the home inside and outside. Census was taken and there were two daycare children present. Current facility sketch (LIC 999A) was reviewed, and Licensees confirmed that the family room, living room, kitchen, and hallway restroom are used for providing childcare and accessible to the daycare children. All other rooms are off-limits and made inaccessible to the daycare children as all doors were locked. There is a fireplace located in the family room and living room, and the fireplaces are made inaccessible to the children as licensees are using a fire screen. Licensees stated that there are no firearms in the home. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are inaccessible.

This is a single level home and there are no stairs. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills were not conducted at least once every six months as there was no proof of documentation with the date, time and how many children present. A deficiency of Type B citation was issued during today’s inspection.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There is no animal in the home. The outdoor play area in the backyard is accessible to the children and is fenced and there are no hazards to children present. There is no swimming pool or other bodies of water on the premises.

(Continued on LIC809-C).

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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 6
Document Has Been Signed on 09/21/2023 01:04 PM - It Cannot Be Edited


Created By: Ka Vang On 09/21/2023 at 11:44 AM
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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensees did not comply with the section cited above. Record review indicated that licensees did not conduct a fire and disaster drills at least once every six months. The last time, licensees conducted the fire and disaster drills were on 01/16/2023. This poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
Licensees agrees that they will implement the regulation CCR 102417(g)(9)(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. Licensee is to submit proof of how they implement the regulation in their daycare. Licensee also to provide proof of their current conducted fire and disaster drills to Community Care Licensing (CCL)-Fresno office by 09/28/2023.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensees did not comply with the section cited above. Record review indicated licensees did not have any proof that she has been documenting the safe sleep 15 minute logs for Child #2 (C2). This poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
Licensees stated they will document the safe sleep 15 minutes log for C2 and will submit proof of safe sleep logs for C2 to CCL.
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:Rene Mancinas
LICENSING EVALUATOR NAME:Ka Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 09/21/2023 01:04 PM - It Cannot Be Edited


Created By: Ka Vang On 09/21/2023 at 11:44 AM
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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
During record review, the licensees did not comply with the section cited above. Record review indicated that there were no proof of immunization records in file for Child #1 (C1) and Child #2 (C2).
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
Per licensees, she will immediately contacted C1 and C2 parents to obtain their current immunization records and submit the immunization records proof to CCL-Fresno by 09/28/2023.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensees did not comply with the section cited above. Record review indicated that Child #1 (C1) and Child #2 (C2) did not have the following records and/or forms in their file: LIC 282, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9224 Acknowledgment of Receipt of Licensing Reports. This poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
Per licensees, they will immediately and contact parents to submit the following records and/or forms to licensees to file in the children’s file. Licensees agree to submit proof of the records and/or forms to CCL-Fresno by 09/28/2023.
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:Rene Mancinas
LICENSING EVALUATOR NAME:Ka Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162
VISIT DATE: 09/21/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.



Licensees has one enrolled in the facility. Licensees understands that there shall be one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Licensees were not able to provide proof of physically checking on infants every fifteen minutes document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a sleeping log. A deficiency of Type B citation was issued during today’s inspection. Licensees understands that infants can be visually observed through an open door if sleeping in a separate room.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were not complete with emergency information as required. A deficiency of Type B citation was issued during today’s inspection. Licensee (Staff #1) Mandated Reporter training was completed on 04/14/2022. Licensee (Staff #2) Mandated Reporter training was completed on 04/14/2022.

(Continued on LIC809-C).

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162
VISIT DATE: 09/21/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Licensee (Staff #1) pediatric CPR/First Aid expires on 09/2023. A review of records indicates that Licensees have immunization records on file for influenza, pertussis, and measles.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA and Licensees discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.



Licensees were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiencies are being cited during today’s inspection. (See next page, LIC809-D).

Licensees were provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Margarita Pulido. During the exit interview, the Licensee Margarita Pulido confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6