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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911360
Report Date: 04/14/2021
Date Signed: 04/15/2021 04:25:22 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:
04/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anna FarfanTIME COMPLETED:
12:00 PM
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    A second announced pre-licensing inspection was conducted today by Licensing Program Analyst (LPA), Norma Lomeli. Met with Applicant, Anna Farfan. Applicant, her two adult daughters, her son in law and two minor children reside in the home.

The purpose of today's inspection is to verify that the following corrections requested were made. LPA observed the following correction during today's inspection:
  • LPA observed that the two pool gates are self-closing/self-latching and swing away from the pool.
  • Applicant installed hook and eye locking devices to two doors that lead to rooms that are now inaccessible to the day care children.
  • During today's inspection, LPA observed the entrance to the home's day care will be through the side door of the home's garage. Applicant installed a room divider that now makes the potential hazardous items that are stored in the garage inaccessible to the day care children.
  • Applicant provided LPA with a copy of her Pediatric CPR and First Aid certification that was completed through American Red Cross and expires on November 12, 2021.

Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 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: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
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: FARFAN, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 103911360
VISIT DATE: 04/14/2021
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  • LPA observed that the rod iron fence is more than five feet tall, there are two gates that swing away from the pool and are self closing/self latching but the self latching device is more than six inches from the top gate. Per Title 22 Regulations state that the self-latching devices must be no more than six inches from the top of the gate.

Pending verification of the correction of the above item and a third prelicensing inspection of her home, 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: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
LIC809 (FAS) - (06/04)
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