153910465-6-13-2019-04-CC-TMAZ-BD4T99-20190613143134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910465
Report Date: 06/13/2019
Date Signed: 06/13/2019 02:31:40 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:	BANOS, PERLA FAMILY CHILD CARE		FACILITY NUMBER:	153910465
ADMINISTRATOR:	BANOS, PERLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 600-8830
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93313
CAPACITY:	14	CENSUS: 5	DATE:	06/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:38 PM
MET WITH:	Perla Banos		TIME COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Annual inspection and met with Licensee Perla Banos. LPA Marquez conducted a tour of the home, inside and outside. The rooms accessible to children in care are: the family room, the kitchen, the day-care room, the hallway bathroom, and the back yard. Off-limits rooms are made inaccessible via plastic door knob spinners. The working telephone number 661-600-8830 was verified. No pets were observed during today's inspection. There are no "bodies of water", firearms, nor a fireplace in this home. A working fire extinguisher is present. A smoke detector and carbon monoxide indicator were tested and observed to be operational. There are no stairs in the home. Adequate supervision is being provided during this inspection. Children are supervised when outside in the fenced play area. Licensee has a current roster of the children. A random sample of Children’s files were reviewed for documentation of immunizations. Staff files were reviewed for record of immunizations for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Right (LIC995A). Fire drills are conducted and documented with the date and time every six months. All adults who reside or work in the home have a criminal record clearance. Pediatric CPR/First Aid is current and expires 01/27/2021. Mandated Reporter training AB 1207 is current and expires 01/02/2020. 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. Postings such as facility license, Emergency Disaster Plan, Earthquake preparedness checklist, and Notification of Parent’s Rights are posted on the day care room wall.

Days and hours of operation are Monday – Friday; 7:30 AM –5:30 PM.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

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: BANOS, PERLA FAMILY CHILD CARE	FACILITY NUMBER: 153910465
	VISIT DATE: 06/13/2019

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LPA & Licensee discussed the Community Care Licensing (CCL) website, newly proposed Safe Sleep regulations and the new additions to the website that include the Provider Information Notifications (PIN), including the Quarterly Updates that informs licensees of new legislation and regulations.

LPA discussed Incidental Medical Services (IMS) and provided Licensee with a copy of the Plan for IMS – Family Child Care Home Requirements (FCCH). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for FCCH Section 102417. No IMS are being provided at this time.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

THE LICENSING FORM (LIC) 9213 NOTICE OF SITE VISIT IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

LIC809 (FAS) - (06/04)

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