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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908457
Report Date: 05/20/2019
Date Signed: 05/20/2019 05:59:08 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:PEREZ, VIRGINIA FAMILY CHILD CAREFACILITY NUMBER:
103908457
ADMINISTRATOR:PEREZ, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 646-2248
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY:14CENSUS: 5DATE:
05/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Virginia PerezTIME COMPLETED:
12:10 PM
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"Spanish speaker" Licensing Program Analyst (LPA) Diana Martinez conducted an unannounced annual/random inspection. LPA met with licensee Virginia Perez. Also present was assistant Laura Estrada. Five children were present today. LPA conducted an interior and exterior tour of the home. Care and supervision are provided in an attached room designated as the day care room and it is accessed from the front yard. The day care room, kitchenette, and bathroom in day care room are the only accessible rooms to day care children. Children do not have access to the rest of the house. Day care is run as a preschool as children are being taught a preschool curriculum, i.e., numbers, letters and site words. Meals are prepared in the main kitchen and eaten in the day care room. Off-limits rooms are made inaccessible by the use of a child safety gate placed at the entry that leads to the rest of the house. Safe, healthful, and comfortable accommodations, furnishings, and equipment were observed. Also observed were safe toys, play equipment, and materials. Licensee does not have any pets. 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. Fireplace in living room is inaccessible to children. Fireplace is not used during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. Stairs are barricaded when children under age 5 years old are present. There is a working landline telephone and number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. A current roster of the children in care is maintained. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations against pertussis, measles and influenza for herself and assistants. Pediatric CPR/First Aid are current with the expiration date of 9/24/19.

LPA discussed Incidental Medical Services (IMS) policy and provided handout Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.


(See next page)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Diana D MartinezTELEPHONE: (559) 341-4670
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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: PEREZ, VIRGINIA FAMILY CHILD CARE
FACILITY NUMBER: 103908457
VISIT DATE: 05/20/2019
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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.

Licensee has provided parents with a copy of the Identification and Emergency Information form (LIC 700). Fire drills are conducted and documented with the date and time every month. 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. 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.

Days and hours of operation are Monday – Friday from 4:30 AM – 5:30 PM.

LPA reviewed and provided information to licensee regarding safe sleep, lead exposure, parents’ board, children's files, and instructions on accessing PINs and quarterly updates. LPA also discussed with licensee that if no assistant provider is present at a large FCCH, then licensee must comply with the capacity requirements for a small FCCH. LPA provided a packet of licensing forms.



Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies cited during today's visit.

An exit interview was conducted with licensee Virginia Perez and a copy of this report was provided and discussed. A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Diana D MartinezTELEPHONE: (559) 341-4670
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2