103909685-7-27-2021-04-CC-LGAN-C5BPSM-20210727113434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103909685
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:34:42 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:	LARA, ANNETTE FAMILY CHILD CARE		FACILITY NUMBER:	103909685
ADMINISTRATOR:	LARA, ANNETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 776-5770
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	14	CENSUS: 4	DATE:	07/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Annette Lara		TIME COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 07/27/2021, Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA was greeted by Licensee Annette Lara 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 minor child, a fingerprint-cleared live-in adult relative/assistant. Present during today’s inspection were four children. The areas of the home that are accessible to the daycare children are daycare room, family room, living room, kitchen, bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by child safety gates and doorknob spinners. Licensee stated there is a cat and a small dog present in the home; Licensee is aware of the safety of children around animals. There are no bodies of water in this home. Licensee stated there are no firearms in this home. No poisons were observed during the inspection. Detergents, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by glass door and will not be in use during daycare hours. There is a working fire extinguisher, which was purchased within the last year. 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. Stairs are barricaded when children under age 5 years old are present. Safe toys and play equipment were observed. There are currently no infants in care. LPA discussed Safe Sleep Regulations with Licensee. There shall be one crib or play yard for each infant in care, cribs and play yards shall be kept free from all loose articles and objects while infants are sleeping, and there shall be no objects hanging above or attached to the crib or play yard. Infants shall not be swaddled while in care. Infants up to 12 months of age shall be placed on their backs for sleeping. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
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)

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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: LARA, ANNETTE FAMILY CHILD CARE	FACILITY NUMBER: 103909685
	VISIT DATE: 07/27/2021

NARRATIVE

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Licensee shall physically check on sleeping infants every 15 minutes and document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants shall be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan shall be completed and in file for each infant up to 12 months of age.

There is a working telephone and cellphone number was verified. Adequate supervision is being provided during this inspection. Licensee is aware that children shall not be left in parked vehicles. Children are supervised when outside in the play area and there are no hazards to children present. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files, which were all complete with emergency information as required. Licensee maintains documentation of immunizations for influenza, pertussis, and measles for herself and staff. Licensee completed the online Pediatric CPR/First Aid training on 03/23/2021 and will schedule the in-person portion of the training. Licensee’s Mandated Reporter training certificate was completed on 04/20/2021. 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 a.m. – 4:30 p.m.

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.

This facility does not provide Incidental Medical Services – IMS. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disabilities Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
(Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
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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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: LARA, ANNETTE FAMILY CHILD CARE	FACILITY NUMBER: 103909685
	VISIT DATE: 07/27/2021

NARRATIVE

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LPA & Licensee discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms, and Regulations. Licensee stated she is receiving PINs and updates through email.

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 is provided and 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: 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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