103910560-11-1-2019-04-CC-LGAN-BHHUEW-20191101153149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103910560
Report Date: 11/01/2019
Date Signed: 11/01/2019 03:31:55 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:	NAST, NICOLE FAMILY CHILD CARE		FACILITY NUMBER:	103910560
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	11/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Nicole Nast		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced annual/random inspection. LPA was greeted by Licensee Nicole Nast who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Present during today’s inspection were five children. The areas of the home that are accessible to the daycare children are living room, daycare room, kitchen, dining area, one bedroom, hallway bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by locked doors and door knob spinners. Licensee is reminded that all “off-limits” rooms must be made inaccessible at all times when daycare children are present. One small dog was 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. Licensee assisted in testing the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

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. 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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

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: NAST, NICOLE FAMILY CHILD CARE	FACILITY NUMBER: 103910560
	VISIT DATE: 11/01/2019

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Pediatric CPR/First Aid are current expiring on 08/15/2020. Mandated reporter certificate is current expiring on 09/10/2020. 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 – 5:30 PM.

LPA discussed Incidental Medical Services (IMS). 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.” LPA left the “Effects of Lead Exposure” brochure with instructions for Licensee to provide a copy to each parent / authorized representative of each enrolled child.

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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

LIC809 (FAS) - (06/04)

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