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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910949
Report Date: 06/20/2019
Date Signed: 06/20/2019 11:17:48 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:SANDOVAL, MARIA FAMILY CHILD CAREFACILITY NUMBER:
103910949
ADMINISTRATOR:SANDOVAL, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 900-5918
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:14CENSUS: 0DATE:
06/20/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria SandovalTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Maria Sandoval for a pre-licensing inspection. Applicant, her Adult Daughter, Esmeralda Sandoval who is also her assistant and two minor children reside in the home. 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. Fire clearance was granted on June 17, 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 17, 2019. Fire alarm is located on the wall in the living room #1 (day care room).
  • This is a single story, four bedrooms and three bathrooms home and children will have access to the living room #1 (day care room). Off-limits rooms are made inaccessible by use of plastic door knob cover. Applicant provided a copy of the certificate of completion certifying that the modification completed in the converted garage meets the requirements set forth in the City of Kerman Municipal Code. The garage conversion will serve as the primary day care room. The day care room has insulated walls, new electric outlets, an electric AC/Heater unit on the northeast wall, tile flooring, carpeting and a bathroom. The living room #1 (day-care room) will be accessed through a newly installed French doors. The living room #1 (day care room) and the bathroom will be the only accessible rooms to day care children. Day care children will not have access to the rest of the house. Meals will be prepared in the kitchen and brought into, served and eaten in the living room #1 (day-care room).
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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: SANDOVAL, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 103910949
VISIT DATE: 06/20/2019
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  • Applicant completed the Mandated Reporter Training on January 12, 2018. Assistant completed the Mandated Reporter Training on January 10, 2018.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts.
  • 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 5:00 PM and Saturday from 5:00 AM to 3:00 PM. No overnight care will be provided.

Licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective June 21, 2019.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 3 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: SANDOVAL, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 103910949
VISIT DATE: 06/20/2019
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  • LPA observed children size furniture, safe toys and books for the children. There is a parent's board. LPA also observed a flat screen television mounted on to the wall. Children will nap in the living room #1 (day care room) on cots and infants will nap in a crib or a play yard. 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 located in the living room #1 (day care room).
  • Applicant’s and applicant’s assistant’s CPR and First Aid certification was completed through Pediatric Plus with certified EMSA stickers are current and expire on 5/14/2020.
  • Preventative Health and Safety class was completed on May 30, 2019.
  • Knives are inside a kitchen drawer and medications are stored in the master bedroom. Both room are areas inaccessible to the day care children.
  • 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 are no bodies of water in the home or premises.
  • There is a small dog that is kept indoors in the main part of the home which is an area 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, ammunition or poisons in the home or premises.
  • 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 not 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 East-side run of the home is the outdoor play area for the children. LPA observed that there is a gated cemented area with a wooden patio porch for shade. There are tricycles, a picnic bench and a water/sand table for the children.
  • SB 792 immunizations verified and on file.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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