103903207-1-10-2020-04-CC-LGAN-BKPQQ2-20200110112137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103903207
Report Date: 01/10/2020
Date Signed: 01/10/2020 11:21:42 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:	HOLGUIN, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	103903207
ADMINISTRATOR:	HOLGUIN, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 299-2346
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	14	CENSUS: 11	DATE:	01/10/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Sandra Holguin		TIME COMPLETED:	11:30 AM

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Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced annual inspection. LPA was greeted by Licensee Sandra Holguin who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present was Licensee’s fingerprint-cleared husband Gilbert Holguin. Present during today’s inspection were 11 children. The areas of the home that are accessible to the daycare children are the living room, kitchen, learning center, two bedrooms for napping, hallway bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by hook and eye latch. No pets were observed during today's inspection. There are no "bodies of water" in this home. Firearms and ammunition are properly stored. Licensee stated poisons are locked in the off-limits garage. Cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, and Licensee was advised to either purchase a new one or get it serviced annually, according to manufacturer’s recommendations. 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 the 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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

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: HOLGUIN, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103903207
	VISIT DATE: 01/10/2020

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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 10/05/2021. Mandated reporter certificate was verified for all staff; Licensee’s certificate is current, expiring on 12/28/2020. 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; 6:30 a.m. – 6:00 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 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: 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. Licensee is receiving PINs through email. LPA thoroughly discussed safe sleep practices and left a copy of “Safe Sleep in Child Care.” LPA left a copy of the “Effects of Lead Exposure” brochure with instructions to distribute to all parents/authorized representatives.

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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

LIC809 (FAS) - (06/04)

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