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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103905726
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:36:33 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:FERNANDEZ, ROSALVA FAMILY CHILD CAREFACILITY NUMBER:
103905726
ADMINISTRATOR:FERNANDEZ, ROSALVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 227-3642
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rosalva FernandezTIME COMPLETED:
03:45 PM
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An unannounced 1 Year Required inspection was conducted today by Licensing Program Analyst, Norma Lomeli. Present during the inspection was licensee, Licensee’s Assistant, Kimberly Gonzalez and 14 day care children that were napping. LPA observed toddler children napping on mats and infants napping in play yards. Licensee, her husband and one minor child reside in the home. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance.
  • The licensee has current pediatric CPR and First Aid certification that expires on July 6, 2022. Licensee’s assistant has current pediatric CPR and First Aid that expires on December 13, 20202. Preventative Health Practice was completed and confirmed at pre-licensing inspection.
  • The home is clean and orderly, with heating and ventilation for safety and comfort.
  • Observed children size furniture for the children in care. Also observed safe toys, play equipment, and materials.
  • A current roster of children in care is maintained. Verified that immunizations records are maintained and license updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative.
  • The licensee ensures that children in care are supervised at all times.
  • Fire and disaster drills are conducted at least once every six months, and documented with the date and time.
  • Licensee states there are no firearms, ammunition or poisons in the home.
  • Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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 3
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: FERNANDEZ, ROSALVA FAMILY CHILD CARE
FACILITY NUMBER: 103905726
VISIT DATE: 07/27/2021
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  • There is a fireplace in the family room that is not used during day-care hours. Licensee is advised that the fireplace is to be screened when in use to prevent access by children.
  • Facility has a 3A40BC fire extinguishers and smoke detectors that meet State Fire Marshall standards. Facility has a working carbon monoxide detector that meets the statutory requirements.
  • An in-ground pool was observed and is fenced in accordance with Title 22 Regulations.
  • Licensee states she maintains licensed capacity at all times.
  • Licensee is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a).
  • SB 792 Implementation for required immunizations effective September 1, 2016 was discussed.
  • Licensee completed the Mandated Reporter Training on July 7, 2021. Licensee’s Assistant complete the training on July 16, 2021.
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

LPA & licensee discussed the Community Care Licensing 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. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

(Continued on LIC809-C):

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FERNANDEZ, ROSALVA FAMILY CHILD CARE
FACILITY NUMBER: 103905726
VISIT DATE: 07/27/2021
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Hours or operation are Monday through Friday from 6:30 AM to 5:30 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee understands children may not be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.

In the areas that were evaluated no deficiencies were observed at the time of the inspection.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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