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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900153
Report Date: 03/06/2020
Date Signed: 03/06/2020 10:22:34 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:CARMONA,PHYLLISFACILITY NUMBER:
103900153
ADMINISTRATOR:CARMONA,PHYLLISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 299-5549
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:14CENSUS: 11DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Phyllis CarmonaTIME COMPLETED:
10:35 AM
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On March 6, 2020, Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA was greeted by Licensee Phyllis Carmona who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches provided. Also present was a fingerprint-cleared live-in adult relative and three fingerprint-cleared assistants. Present during today’s inspection were 11 children. The areas of the home that are accessible to the daycare children are the two daycare rooms, bathroom, and fenced portion of the backyard. “Off-limits” rooms are made inaccessible by child safety gate and doorknob spinner. No pets were observed during today's inspection. There are no bodies of water in this home. Firearms and ammunition are locked and stored separately according to regulation. Licensee stated the poisons are locked. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children. There is a working fire extinguisher, which was last serviced on 01/22/2020. LPA tested the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

There is a working telephone and cellphone number was verified. Adequate supervision is being provided during this inspection. Children are supervised when outside in 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 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. Licensee is aware that children are never to be left in parked vehicles.

(Continued on next page, LIC809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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 2
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: CARMONA,PHYLLIS
FACILITY NUMBER: 103900153
VISIT DATE: 03/06/2020
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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.

Pediatric CPR/First Aid are current expiring on 04/20/2021. Mandated reporter certificate was completed on 02/24/2020. 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. Days and hours of operation are Monday – Friday; 7:30 a.m. – 5:30 p.m.

LPA discussed Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding the Americans with Disabilities Act (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.



LPA & Licensee discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms, and Regulations. Licensee stated she is receiving PINs and updates through email. LPA thoroughly discussed safe sleep practices and left a copy of the safe sleep brochure. LPA discussed infant items permitted in Family Child Care Homes and left a visual handout. LPA provided Licensee with the “Effects of Lead Exposure” brochure in accordance with AB 2370, Chapter 676, Statutes of 2018.

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 is required to be posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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