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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900094
Report Date: 02/10/2020
Date Signed: 02/10/2020 02:24:05 PM

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:SANDOVAL,TERESAFACILITY NUMBER:
103900094
ADMINISTRATOR:SANDOVAL,TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 453-2554
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 6DATE:
02/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Teresa SandovalTIME COMPLETED:
02:45 PM
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On 02/10/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced annual inspection. LPA was greeted by Licensee Teresa Sandoval who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Present during today’s inspection were six (6) children. Rooms accessible to children are the kitchen, day care room, living room, and hall bathroom. Days and hours of operation are Monday – Friday; 7:00AM to 5:30PM.

LPA observed one dog at the home. There is a swimming pool which is fenced according to regulations. There is a working fire extinguisher, smoke detectors, and carbon monoxide detector. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the backyard play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A).

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. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

Licensee is aware that children are never to be left in parked vehicles.

Pediatric CPR/First Aid are current expiring in March of 2021. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SANDOVAL,TERESA
FACILITY NUMBER: 103900094
VISIT DATE: 02/10/2020
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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 she provides these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, and Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
LIC809 (FAS) - (06/04)
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