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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911639
Report Date: 10/10/2022
Date Signed: 10/10/2022 10:33:04 AM

Document Has Been Signed on 10/10/2022 10:33 AM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HAYNES, JILL FAMILY CHILD CAREFACILITY NUMBER:
543911639
ADMINISTRATOR:HAYNES, JILLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 429-4112
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jill HaynesTIME COMPLETED:
10:45 AM
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On 10/10/2022 Licensing Program Analyst (LPA) Diane Mercado, conducted an unannounced Annual Required Inspection and was met by Licensee, Jill Haynes. Days and hours of operation are Monday-Friday 7am-5pm. LPA toured the home inside and outside and a census was taken (0 children). Current facility sketch reviewed, and. Licensee confirmed that the living room, dining room, kitchen, one bedroom, hall bathroom, and a portion of the backyard (i.e. play yard) are used for providing care and are accessible to children. Backyard is currently not used at this time due to backyard fencing for children’s area was knocked down. All other rooms are off-limits and made inaccessible by use of plastic door spinners. Licensee has been licensed at this home since November 02, 2021 and has no children enrolled.

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 made inaccessible. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 429-4112. There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. 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 currently not fenced. Capacity as specified on the license is being maintained.


Continued 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HAYNES, JILL FAMILY CHILD CARE
FACILITY NUMBER: 543911639
VISIT DATE: 10/10/2022
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LPA was not able to review a sample of children’s files due to no children being enrolled. Licensee’s Mandated Reporter Training was not completed. Licensee stated was still in the process of completing training. Licensee’s pediatric CPR/First Aid expires on 10/12/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home do not have a criminal record clearance or exemption. There is one excluded individual present at this home. Adult #1 is present at time of inspection. Licensee does not have children enrolled and requested to go on inactive status.

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

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.

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.


Continued 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2022
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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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HAYNES, JILL FAMILY CHILD CARE
FACILITY NUMBER: 543911639
VISIT DATE: 10/10/2022
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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.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Jill.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2022
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Document Has Been Signed on 10/10/2022 10:33 AM - It Cannot Be Edited


Created By: Diane Mercado On 10/10/2022 at 10:10 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: HAYNES, JILL FAMILY CHILD CARE
FACILITY NUMBER: 543911639

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and records review, the licensee did not comply with the section cited above as today, LPA observed Adult #1, within the family child care home. Licensee stated that Adult #1 does not reside in the home and lives down the street at his grandfathers ranch. Upon records review, LPA found that the Adult #1 has not obtained criminal background clearance as required. This poses an immediate health, safety or personal rights risk to persons in care. Civil penalty assessed.
POC Due Date: 10/11/2022
Plan of Correction
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Licensee stated she will ensure Adult #1 undergoes live scan processing in order to obtain the proper background clearances. Licensee stated submit paperwork to CPMB to try and obtain exemption clearance for Adult #1. Licensee understands that until background clearance is obtained, Adult #1 is not permitted to provide child care services, or reside within the Family Child Care Home.
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:Susie Fanning
LICENSING EVALUATOR NAME:Diane Mercado
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2022


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