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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909456
Report Date: 10/04/2019
Date Signed: 10/04/2019 11:35:18 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:CARDENAS, SHANNON FAMILY CHILD CAREFACILITY NUMBER:
103909456
ADMINISTRATOR:CARDENAS, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 593-2491
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:14CENSUS: 14DATE:
10/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Shannon CardenasTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced annual inspection. LPA was greeted by Licensee Shannon Cardenas who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present were Licensee’s fingerprint-cleared husband and minor daughter. Present during today’s inspection were 14 children. The areas of the home that are accessible to the daycare children are the living room, dining room, daycare room, kitchen, downstairs bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by lever lock. Three dogs and three cats were observed during today’s inspection; Licensee is aware of the safety of children around animals. Licensee stated there are no firearms in this home. Swimming pool is fenced per regulation. Licensee stated there are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by glass screen. There is a working fire extinguisher. LPA tested the smoke detector, which was in working condition. The home has adequate heating and ventilation for safety and comfort. Stairs are barricaded when children under age 5 years old are present.

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.

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.(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: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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: CARDENAS, SHANNON FAMILY CHILD CARE
FACILITY NUMBER: 103909456
VISIT DATE: 10/04/2019
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Pediatric CPR/First Aid are current expiring on 03/31/2021. Mandated reporter certificate is current expiring on 08/02/2020. 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; 7:00 AM – 4:30 PM.

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. 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. LPA thoroughly discussed safe sleep practices and left a copy of “Safe Sleep in Child Care.”

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

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2