153910278-11-23-2021-04-CC-RIGS-C92VWW-20211123154837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910278
Report Date: 11/23/2021
Date Signed: 11/23/2021 03:48:42 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:	LOPEZ, JUANA FAMILY CHILD CARE		FACILITY NUMBER:	153910278
ADMINISTRATOR:	LOPEZ, JUANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 721-0828
CITY:	DELANO	STATE: CA	ZIP CODE:	93215
CAPACITY:	14	CENSUS: 4	DATE:	11/23/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Lopez, Juana		TIME COMPLETED:	04:00 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	On 11/23/2021 Licensing Program Analyst (LPA), Roman Iglesias, conducted an unannounced Case Management inspection and was met by Spanish speaking Licensee, Juana Lopez. LPA conducted a Covid-19 safety screening before entering the facility. Days and hours of operation are Monday through Friday from 5:00 a.m. to 5:00 p.m. LPA toured the home inside/outside and a census was taken. LPA also reviewed the most current facility sketch and Licensee confirmed that the flex room, hallway bathroom, and bedroom number four are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic child doorknob and child safety gate. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (661) 586-1224. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 7/13/2021. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Incidental Medical Services (IMS) are not currently being provided. (Continued on 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Roman Iglesias	TELEPHONE: (916) 809-3236
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

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 2

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: LOPEZ, JUANA FAMILY CHILD CARE	FACILITY NUMBER: 153910278
	VISIT DATE: 11/23/2021

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
26
27
28
29
30
31
32

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

Exit interview conducted and report was reviewed with the facility representative, Juana Lopez.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Roman Iglesias	TELEPHONE: (916) 809-3236
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2