103900136-5-30-2019-04-CC-TMAZ-BCNQ4Y-20190530115107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103900136
Report Date: 05/30/2019
Date Signed: 05/30/2019 11:51:16 AM

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:	COSON,GWENITH		FACILITY NUMBER:	103900136
ADMINISTRATOR:	COSON,GWENITH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 431-0548
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	14	CENSUS: 8	DATE:	05/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Gwenith Coson		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Annual inspection and met with Licensee Gwenith Coson. Also present was Licensee’s spouse Raymond Coson and Assistant Sabrina Mortensen. LPA Marquez conducted a tour of the home, inside and outside. Off-limits rooms are made inaccessible via children’s safety gate. No pets were observed during today's inspection. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. There are no Firearms in the home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is screened and inaccessible to children in care. A working fire extinguisher is present. Smoke detector and carbon monoxide indicator observed to be operational. There are no stairs in the home. The working telephone number 559-431-0548 was verified. Adequate supervision is being provided during this inspection. 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 does not maintain documentation of immunizations against pertussis, measles or influenza for herself or staff. Licensee maintains documentation of immunizations for pertussis, measles and influenza for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Pediatric CPR/First Aid is current and expires 03/15/2021. 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 advance notice. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and notification of parents rights poster are posted on facility entrance wall.

Days and hours of operation are Monday – Friday; 7:30 AM – 5:30 PM.

Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

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: COSON,GWENITH	FACILITY NUMBER: 103900136
	VISIT DATE: 05/30/2019

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This facility does not provide Incidental Medical Services (IMS). The requirements of a IMS plan was provided to Licensee for future reference.

LPA & licensee discussed the Community Care Licensing website, safe sleep regulations and Mandated Reporter Training. LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation 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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

LIC809 (FAS) - (06/04)

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