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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910927
Report Date: 06/10/2019
Date Signed: 06/10/2019 06:57:05 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:ROSALES, HILDA FAMILY CHILD CAREFACILITY NUMBER:
103910927
ADMINISTRATOR:ROSALES, HILDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 326-8801
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 0DATE:
06/10/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Hilda RosalesTIME COMPLETED:
07:10 PM
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Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Hilda Rosales for a pre-licensing/ change of location inspection. Applicant, her husband and three minor children reside in the home. Licensee’s Assistants will be Jackelinne Villegas or Rosa Martinez. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on June 3, 2019.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on June 7, 2019. Fire alarm is located on the dining room wall near the garage door.
  • This is a single story, three bedrooms and two bathrooms home and children will have access to the living room, dining room, kitchen, bedroom #2, bedroom #3 and hallway bathroom. Off-limits rooms are made inaccessible by use of key locks and plastic door knob covers.
  • There is a fireplace in the living room that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture, safe toys, and books for the children. Children will nap in the living room on cots and mats. Infants will nap on play yards. Applicant understands she is to supervise children at all times.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
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 3
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: ROSALES, HILDA FAMILY CHILD CARE
FACILITY NUMBER: 103910927
VISIT DATE: 06/10/2019
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 5:00 AM to 6:00 PM and as arranged.



Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
  • Applicant will make a sliding door located in the master bedroom inaccessible to the in-ground pool that is located in the backyard. LPA will return for a second inspection.

Pending verification of correction, the above items and a final review of her application, Provisional License as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended pending proof of Preventative Health and Safety certification.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ROSALES, HILDA FAMILY CHILD CARE
FACILITY NUMBER: 103910927
VISIT DATE: 06/10/2019
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  • Applicant’s Pediatric CPR and First Aid certification through Pediatric Plus with EMSA certified stickers are current and expires on 8/18/2020.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant 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.
  • There is an in-ground pool that is fenced with rod iron fence in accordance with Title 22 Regulations. The gate is self-latching/self-closing and swings away from the pool. LPA observed a door in the master bedroom that leads to the in-ground swimming pool.
  • There is a large dog that is kept gated in the pool area and will be inaccessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no weapons, firearms or ammunition in the home or premises. Poisons are kept locked inside a white cabinet that is located in the garage.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant states the home is smoke-free.
  • Applicant states she will be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard has a cemented and a large sodded area for the children. LPA observed a Backyard Discovery swing/slide wooden play structure, tricycles, Little Tikes playhouse and other safe toys for the children.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on February 5, 2019.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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