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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909797
Report Date: 10/24/2022
Date Signed: 10/24/2022 02:13:09 PM

Document Has Been Signed on 10/24/2022 02:13 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:MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCCFACILITY NUMBER:
503909797
ADMINISTRATOR:MONTIJO,MAGDALENA/GONZALEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 472-4075
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Magdalena MontijoTIME COMPLETED:
02:30 PM
NARRATIVE
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On 10/24/2022, Licensing Program Analyst (LPA) Jeovanna Yanez, conducted an unannounced Annual Required Inspection and was met by Licensee, Magdalena Montijo. Also present were Staff #1 and Staff #2 (S1/S2). Licensee is Spanish Speaking. Days and hours of operation are Monday – Friday, from 6:30 AM to 5:30 PM.

LPA toured the home inside and outside, and a census was taken. Current facility sketch was reviewed, and Licensee confirmed that the living room, kitchen, dining room, upstairs bedroom #1, upstairs bedroom #2, and upstairs hallway bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety gates and/or door locks. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are inaccessible. The fireplace located in the living room is made inaccessible by a glass door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed the top portion of the stairs are barricaded with a safety gate, but not the bottom portion. LPA advised Licensee another safety gate will need to be placed at the bottom of the stairs. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (408) 472-4075.

Licensee has two infants enrolled. LPA observed one infant asleep in an upstairs bedroom while conducting the inspection. LPA discussed the safe sleep regulations with licensee 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 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. (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCC
FACILITY NUMBER: 503909797
VISIT DATE: 10/24/2022
NARRATIVE
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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. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were missing some documentation. All children's files did not contain form LIC 995. Three children's files did not contain immunization records. Licensee stated she was not aware of the requirement to document the date and time of each 15-minute check, as well as the initials of the individual conducting the check. Licensee’s, S1 and S2 have not completed the required Mandated Reporter training. Licensee, S1 and S2 pediatric CPR/First Aid expires on 03/2024. A review of records indicates that S1 and S2 did not have immunization records on file for influenza, pertussis and measles. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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: https://www.ada.gov/childqanda.htm.



LPA and Licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found: (see LIC809-D)

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Magdalena Montijo. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
Page: 11 of 12
Document Has Been Signed on 10/24/2022 02:13 PM - It Cannot Be Edited


Created By: Jeovanna Yanez On 10/24/2022 at 12:46 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: MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCC
FACILITY NUMBER: 503909797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed the top portion of the stairs are barricaded with a safety gate, but not the bottom portion of the stairs which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee stated she will put up a gate, or barricade, on the bottom of the stairs and take a picture, and send to CCL by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 9 of 12
Document Has Been Signed on 10/24/2022 02:13 PM - It Cannot Be Edited


Created By: Jeovanna Yanez On 10/24/2022 at 12:46 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: MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCC
FACILITY NUMBER: 503909797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above, in that a fire drill has not been documented on a log and there is no other proof of fire drill being conducted, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2022
Plan of Correction
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 Licensee stated she will conduct a fire drill, document the date and time as required, and provide documentation to CCL by POC due date.

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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 12 of 12
Document Has Been Signed on 10/24/2022 02:13 PM - It Cannot Be Edited


Created By: Jeovanna Yanez On 10/24/2022 at 12:46 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: MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCC
FACILITY NUMBER: 503909797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(6)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall be on the same floor as the sleeping infant.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, in that an infant was asleep in an upstairs bedroom while provider were downstairs, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee stated she will review the Infant Safe Sleep regulations, and will submit a written statement indicating how she will ensure that she follows safe sleep regulations for infants to CCL by POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that Licensee, S1 and S2, have not completed the required AB1207 Mandated Reporter training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Licensee stated she, and S1 and S2, will completed the required AB1207 Mandated Reporter training, and submit proof of completion to CCL by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 4 of 12
Document Has Been Signed on 10/24/2022 02:13 PM - It Cannot Be Edited


Created By: Jeovanna Yanez On 10/24/2022 at 12:46 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: MONTIJO, MAGDALENA & GONZALEZ, MARTIN FCC
FACILITY NUMBER: 503909797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in three out of five children's files. Three children did not have immunization records on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee stated she will obtain copies of immunization records for the three children, and will submit documentation to CCL by POC due date.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in five out of five children's files. All children's files did not contain form LIC 995, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee stated she will have parents sign these forms and place in the children's files. Licensee will submit documentation to CCL by POC due date.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
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