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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900505
Report Date: 11/14/2019
Date Signed: 11/14/2019 11:22:13 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:CHAVEZ,STEFFANIEFACILITY NUMBER:
103900505
ADMINISTRATOR:CHAVEZ,STEFFANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 891-8943
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY:14CENSUS: 9DATE:
11/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Steffanie ChavezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Diane Mercado conducted an unannounced annual inspection. LPA met with Licensee Steffanie Chavez also present were licensee two assistants. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The entrance to the daycare is on the side of the home on Olive street. The playroom is in the back of the home and is used for daycare. Licensee states that children do not have access to the main part of the home which includes; kitchen, living room, three bedrooms and two bathrooms. Kitchen door leading to the main part of the home is locked and/or have plastic door knob spinners. The rooms accessible to children in care are: playroom, playroom bathroom and backyard. Two small fishes in a fish tank were observed during today’s inspection; licensee is aware of the safety of children around animals. There are no "bodies of water" or firearms in this home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and 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 inspection. Children are supervised when outside in the unfenced 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 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. Licensee is aware that children are never to be left in parked vehicles. 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 is current and expires 09/2020. Mandated Reporter training AB 1207 was completed on 03/26/2018. Days and hours of operation are Monday – Friday; 6:30 AM – 5:30 PM.

Continued 809-C
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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: CHAVEZ,STEFFANIE
FACILITY NUMBER: 103900505
VISIT DATE: 11/14/2019
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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 playroom wall. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

This facility does not provide Incidental Medical Services – IMS. Licensee is aware if IMS is provided an IMS plan will need to be submitted to Community Care Licensing. 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, Lead Poisoning Facts, Forms and Regulations.

Exit interview was conducted with licensee Steffanie Chavez.


Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC809 (FAS) - (06/04)
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