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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911360
Report Date: 01/14/2021
Date Signed: 01/14/2021 04:46:06 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:FARFAN, ANNA FAMILY CHILD CAREFACILITY NUMBER:
103911360
ADMINISTRATOR:FARFAN, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 840-2400
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 0DATE:
01/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Anna FarfanTIME COMPLETED:
05:00 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On January 14, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Anna Farfan for a pre-licensing inspection. Applicant, her two adult daughters and two minor children reside in the home. Applicant’s assistant will be her Adult Daughter, Emmalyn Rodriguez. 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 December 29, 2020.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on January 11, 2021. Fire alarm is located in the home’s laundry room on the wall. The entrance to the home’s child care will be through the East side door that is located next to the garage.
  • This is a single story, four bedrooms and three and a half bathrooms home and children will have access to the family room, dining/kitchen area, family room, laundry room and bathroom. Off-limits rooms are made inaccessible by use of hook and eye latches.
  • There are two fireplaces; one in the family room and one in the living room that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture, safe toys, books and instructional materials for the day care children. Children will nap in the family room on mats. Infants will nap in 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: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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 4
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: FARFAN, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 103911360
VISIT DATE: 01/14/2021
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  • Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on November 11, 2021. Applicant's Assistant completed her certification through American Red Cross and expires on October 5, 2021.
  • Preventative Health and Safety class was completed on October 6, 2020.
  • Knives are stored inside a top kitchen cabinet that is located above the range hood. Medications are stored in the master bedroom. Cleaning compounds are stored inside a top cabinet that is located in the laundry room and in the garage.
  • 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 black rod iron fencing in accordance with Title 22 Regulations. There are two gates that are not self-latching/self-closing and swings away from the pool.
  • There is one dog and a cat that are kept indoors but 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 firearms or ammunition in the home or premises. Poisons are kept locked inside a shed that is located in the backyard.
  • 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 is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(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.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FARFAN, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 103911360
VISIT DATE: 01/14/2021
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  • Fenced backyard will be inaccessible to the day care children. Applicant states that the glass doors that lead to the backyard will be kept locked during day care hours. Applicant states that the day care children will have outdoor play in the home's unfenced front yard. Applicant understands that she must have direct visual supervision of the children when playing in an outdoor unfenced area.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on November 18, 2019.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • 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.

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. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant 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.



Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 60 days to avoid possible withdraw.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: FARFAN, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 103911360
VISIT DATE: 01/14/2021
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  • Applicant will make the two pool gates self-latching/self-closing and will swing away from the pool.
  • Applicant will install a locking device to two doors that lead to rooms that will be made inaccessible to the day care children.
  • Applicant will make the entrance to the home’s day care safe for the day care children. During inspection, LPA observed observed the entrance leads to the garage where potential hazardous items are stored.
  • Applicant will provide LPA with a copy of her Pediatric CPR and First Aid certification.

Pending verification of corrections of the above items, a final review of her application and a second prelicensing inspection, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4