150407803-6-26-2019-04-CC-JTHN-BDHQ7S-20190626115538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 150407803
Report Date: 06/26/2019
Date Signed: 06/26/2019 11:56:12 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:	TREVINO FAMILY DAY CARE		FACILITY NUMBER:	150407803
ADMINISTRATOR:	TREVINO, VIKKI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 871-6914
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93305
CAPACITY:	12	CENSUS: 10	DATE:	06/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Vikki Trevino - Licensee		TIME COMPLETED:	12:00 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	An unannounced Annual/Random Inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with licensee, Vikki Trevino, and a census was taken. Also present during the inspection was licensee’s assistant, Courtney Thomas. A tour of the facility was made and Background clearances were discussed. Licensee has current pediatric CPR and First Aid that expire on 02-16-21. The home is clean and orderly, with heating and ventilation for safety and comfort. he home is clean and orderly. Off-limit rooms are made inaccessible by using spinning plastic door knob covers and child proof gates. Safe, healthful, and comfortable accommodations, furnishings, toys and equipment were observed. There is a working telephone. Licensee has two dogs that are made inaccessible to children by means of gated area in the backyard of the home. Licensee accepts full liability for action taken by family pets. A current roster of children in care is maintained. LPA verified that immunization records are maintained and licensee updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative. Licensee ensures that children in care are supervised at all times. Licensee states there are no firearms or ammunition are in the home. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored where they are inaccessible to children. Facility has required fire extinguisher and smoke detector, both meet State Fire Marshall standards. Facility has one functioning carbon monoxide detector that meets statutory requirements. No bodies of water observed in or on the premises. Licensee understands children may not be left in parked vehicles. Safe sleep practices for infants was discussed and LPA provided the licensee with a handout. Licensee maintains proof of immunization, for herself, within the family child care home. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is aware that forms and updated information may be obtained on the Department’s website www.ccld.ca.gov. (Continued on LIC809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: TREVINO FAMILY DAY CARE	FACILITY NUMBER: 150407803
	VISIT DATE: 06/26/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Hours of operation are Monday through Friday from 7:00 AM to 6:00 PM, and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee is advised that forms and updated information may be obtained on the CCLD website (www.ccld.ca.gov). Licensee is also advised that it is her responsibility to stay current with regulations.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

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