103911420-1-21-2021-04-CC-NLOI-BXGRGT-20210121120115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103911420
Report Date: 01/21/2021
Date Signed: 01/21/2021 12:03:14 PM

Document Has Been Signed on 01/21/2021 12:03 PM - It Cannot Be Edited

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:	HALL, BERNARD FAMILY CHILD CARE		FACILITY NUMBER:	103911420
ADMINISTRATOR:	HALL, BERNARD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 515-6035
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/21/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Bernard Hall		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On January 21, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant and Applicant’s Assistant, Brenda Hall for a pre-licensing change of location inspection. Applicant and his Wife, Brenda Hall who will be assisting Mr. Hall are the only adults who reside in the home. 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 January 8, 2021. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: Fire clearance was received on January 19, 2021. Fire alarm is located on the mother in law suite (day care room) entry way on the left wall. This is a single story, two bedrooms, three bathrooms and a mother in law suite which has its on separate entrance to the day care room and the only room accessible to the day care children. Off-limits rooms are made inaccessible by use of plastic door knob covers. There no fireplace in the home. LPA observed child size furniture, safe toys and books for the children. There is a high chair, a flat screen television mounted onto the wall, a refrigerator and a microwave in the day care room. Children will nap in the day care room on cots and 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):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

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: HALL, BERNARD FAMILY CHILD CARE	FACILITY NUMBER: 103911420
	VISIT DATE: 01/21/2021

NARRATIVE

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Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on July 1, 2022. Applicant’s Assistant completed her certification through American Red Cross and expires on June 30, 2022.
Knives and medications are stored in the kitchen which will be an area inaccessible to the day care children. Cleaning compounds are stored in the laundry room which is a room 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.
Applicant states there are no pets in the home or on the premises.
Applicant states there are no firearms, ammunition or poisons in the home or premises.
Applicant is reminded that any advertising (of day-care) such as business cards, flyation "Advertisements and License Number" 102359 (a).ers/posters, and/or signs must include facility number as per Title 22 Regul
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 he 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 backyard has a large area for the day care children to play. Applicant states that they will walk the day care children through the unfenced front yard to the side run of the home to get to the backyard. Applicant understand that he must have 100% visual supervision of the day care children at all times.
SB 792 immunizations verified and on file.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

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: HALL, BERNARD FAMILY CHILD CARE	FACILITY NUMBER: 103911420
	VISIT DATE: 01/21/2021

NARRATIVE

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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.

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. He is also reminded that it is her responsibility to read the regulations periodically. Applicant states he will operate his day care Monday through Saturday from 7:00 AM to 5:00 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.

Provisional License for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 180 days, pending receipt of the Preventive Health and Safety Training certification and Mandated Reporter Training certification. Provisional license will be effective January 25, 2021.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

LIC809 (FAS) - (06/04)

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