153909988-10-7-2019-04-CC-JPEE-BGQQ48-20191007114955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153909988
Report Date: 10/07/2019
Date Signed: 10/07/2019 11:50:00 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:	MEDRANO,CARMEN/LOPEZ,MARIA & CINDY FCC		FACILITY NUMBER:	153909988
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carmen Medrano		TIME COMPLETED:	12:15 PM

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Licensing Program Analyst (LPA), Jose Penate, conducted an unannounced annual random inspection. LPA met with Licensee, Maria Lopez (Spanish speaking). There are no firearms or ammunition at this home. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There is a fireplace at this home, but it is not being used during daycare hours. Fire drills are being conducted and documented at least once every six months. There is a working telephone and number was verified. There are 4 dogs at this home, they are not accessible to children. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). All individuals residing at the home have criminal background/fingerprint clearances. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Pediatric CPR/First Aid are current and expire on 08/03/2021. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. IMS policy was discussed and is not being provided at this time.

LPA informed Licensee of Safe Sleep practices for infants and how to provide Safe Sleep environments. LPA informed Licensee to visit the Department’s website (www.ccld.ca.gov) for updates and changes related to licensing regulations and procedures.

Business hours are Mon-Sat 5:00 AM to 12:00 AM or as arranged.

Continued on LIC 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: MEDRANO,CARMEN/LOPEZ,MARIA & CINDY FCC	FACILITY NUMBER: 153909988
	VISIT DATE: 10/07/2019

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LPA & licensee discussed the Community Care Licensing website and Mandated Reporter Training: LPA and licensee 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. LPA left a copy of A Child Care Provider’s Guide to Safe Sleep.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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