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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909162
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:04:56 PM

Document Has Been Signed on 12/08/2022 02:04 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
CCLD Regional Office, 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: 1DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Margarita PulidoTIME COMPLETED:
02:15 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 12/08/2022 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez, conducted an unannounced Annual Required Inspection and was met by Licensee, Margarita Pulido. LPA explained the reason for the visit. Also present was Licensee Adolfo Pulido and Adult #1. Licensee is Spanish Speaking and LPA translated throughout the inspection. Days and hours of operation are Monday through Friday from 7:00am to 11:00pm.

LPA toured the home inside and outside and a census was taken of 1. Current facility sketch reviewed and Licensee confirmed that the Living Room, Family Room, Kitchen, Hallway Restroom and Backyard are used for providing care and are accessible to children in care. All other rooms are off-limits and made inaccessible by locked doors. LPA observed three bodies of water on the premises which consist of two filled water fountains in the front yard of facility, and a 5-gallon bucket half filled in the backyard of facility. LPA observed Licensee Margarita remove water from fountains, and dumped out water from blue bucket during inspection. There are no firearms or ammunition on the premises. LPA did not observe any poisons during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. LPA observed two small dogs in facility. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

The fireplace located in the Family Room and is made inaccessible by a glass door. The second electric fireplace is located in Livingroom and is made inaccessible by a glass door. Licensee stated that fireplaces 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 licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. LPA did not observe any stairs in this home. The home has working telephone service and LPA confirmed the phone number is (209) 658-2687.

(Continue LIC809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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 12/08/2022 02:04 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 12/08/2022 at 01:27 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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, LPA observed a three tier water fountain in the front of the facility filled with water and accessible to children. LPA also observed a large vase fountain with the base filled with water in front of the facility accessible to children. LPA observed a blue 5-gallon plastic general bucket half filled with water in the backyard accessible to children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2022
Plan of Correction
1
2
3
4
Licensee removed water from fountains and dumped out water from bucket during inspection. Licensee has agreed to fille water fountains with rocks. Licensee had agreed to watch Bodies of Water Requirements found in the https://ccld.childcarevideos.org website and write a statement on what they have learned.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 12/08/2022 02:04 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 12/08/2022 at 01:27 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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that, LPA observed an open cat litter box by entrance of door way of facility that was accessible to children. LPA observed an open cat litter box in backyard that was accessible to children, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2022
Plan of Correction
1
2
3
4
Licensee placed both litter boxes in inaccessible area's during the inspection on today's date.
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 licensee did not comply with the section cited above in that, Licensee had not conducted a fire drill within the past six months nor had it documented on a log. LPA observed that the last fire drill conducted was on 06/21/21, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
1
2
3
4
Licensee will provide CCL a copy of their recent fire drill on POC due date. Licensee understands that they need to conduct drills at least every 6 months.
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:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/08/2022 02:04 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 12/08/2022 at 01:27 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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that, LPA observed that Licensee Adolfo Pulido did not have a current Mandated Reporter AB 1207, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
1
2
3
4
Licensee Adolfo Pulido will provide a copy to CCL by POC due date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that, LPA observed that Licensee Margarita did not have proof of MMR and TDAP in facility. LPA observed that Licensee Adolfo Pulido did have proof of MMR and TDAP in facility.

which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
1
2
3
4
Licensee Margarita and Adolfo Pulido had agreed to provide CCL with proof of immunization's by POC due date. Licensee's will watch Record Keeping in Family Child Care and write a statement on what they have learned and submit it 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:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
Page: 4 of 6
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: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162
VISIT DATE: 12/08/2022
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
LPA did not observe any infants in care during inspection. Licensee stated that they are not currently caring for any infants. LPA discussed Safe Sleep Regulations with licensee. Licensee understands the following: There shall be at least one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Licensee understands to physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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.

Licensee has a current roster of the children. An emergency fire/disaster drill was last completed on 06/21/2021 and is not current. Licensee understands that an emergency fire/disaster drill must be completed and documented within the last 6 months. Licensee Margarita’s Mandated Reporter Training was completed on 4/14/2022. Licensee Margarita’s pediatric CPR/First Aid expires on 9/30/2023. Licensee Adolfo Pulido does not have a current Mandated Reporter Training. Licensee Adolfo’s pediatric CPR/First Aid expires on 9/30/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza.

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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



(Continue LIC809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PULIDO, MARGARITA & ADOLFO FAMILY CHILD CARE
FACILITY NUMBER: 243909162
VISIT DATE: 12/08/2022
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 Margarita Pulido 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, 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.

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.

LPA discussed the safe sleep regulations with Licensee Margarita Pulido 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 infants devices with the CPSC to be notified of any recalls on their purchased equipment.

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 Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, 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 copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Margarita Pulido.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6