103910069-6-6-2019-04-CC-NLOI-BCVPWN-20190606114100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103910069
Report Date: 06/06/2019
Date Signed: 06/06/2019 11:41:15 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:	AGUILERA, NICHOLE FAMILY CHILD CARE		FACILITY NUMBER:	103910069
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	06/06/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nichole Aguilera		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	Licensing Program Analyst (LPA), Norma Lomeli conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection, was licensee and four day care children. Licensee and her husband reside in the home. Verified licensee, Licensee’s Assistant’s, Amanda Perez, CPR and First Aid certification completed through Pediatric Plus with EMSA certified stickers, certification is current and expires on February January 19, 2021. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared or exemption. Fire clearance was granted on May 28, 2019. A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed: Fire clearance was received on June 3, 2019. Fire alarm is located on the living room wall. LPA observed children size furniture, safe toys, books, a flat screen television mounted to the living room, two play yards and a high chair. Licensee states she does not have weapons, firearms or ammunition in the home or premises. Poisons are stored in a locked cabinet in the garage which is an area inaccessible to the day care children. Facility has 2A10BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

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: AGUILERA, NICHOLE FAMILY CHILD CARE	FACILITY NUMBER: 103910069
	VISIT DATE: 06/06/2019

NARRATIVE

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Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
Licensee states the home is smoke-free.
Licensee states she will not be transporting day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Required items are posted in the Child Care Home where parents may easily view.
During visit capacity worksheet was provided and discussed.
Licensee completed the Mandated Reporter Training on March 25, 2018. Licensee’s Assistant completed the training on January 28, 2019.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.

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.

Licensee states her hours of operation are Monday through Friday from 7:00 AM to 5:30 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

The home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of the California Code of Regulations and is adequate for a Large Family Day Care Home (LFDCH). Licensure as a Large Family Day Care Home capacity of 14 children will be recommended effective June 10, 2019.

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.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

LIC809 (FAS) - (06/04)

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