153910711-6-11-2019-04-CC-GRES-BD2R3U-20190611124032

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910711
Report Date: 06/11/2019
Date Signed: 06/11/2019 12:40:39 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:	PRUNEDA, DORA FAMILY CHILD CARE		FACILITY NUMBER:	153910711
ADMINISTRATOR:	PRUNEDA, DORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 910-4394
CITY:	SHAFTER	STATE: CA	ZIP CODE:	93263
CAPACITY:	14	CENSUS: 11	DATE:	06/11/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:			TIME COMPLETED:	01:00 PM

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An unannounced Case Management (90 day post-license) inspection was conducted today by Licensing Program Analyst (LPA) Gloria Reyes. LPA met with Licensee, Dora Pruneda. Also, present is Assistant, Maria Chavez. The individuals who reside in the home are the licensee, licensee's two adults son, and licensee's adult sister. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight. LPA toured the facility and census taken. The rooms that will be accessible to day care children are the family room, dining room, kitchen, and hall bathroom. The remaining rooms are made inaccessible with child's safety gate. Fireplace is made inaccessible by a bookcase. Licensee has installed child proof latches on the all the cabinets. Day care toys and equipment were evaluated. There are no firearms nor bodies of water at this facility. Licensee does not have any pets. LPA observed a 2A-10BC fire extinguisher, smoke detector, carbon monoxide detector and a first aid kit. Licensee maintains a fire drill log and a child roster. Children’s files were reviewed. Licensee's Pediatric CPR and Pediatric First Aid certification expires on 12/02/19.
LPA reviewed the required immunizations and the Mandated Child Abuse Reporter (AB 1207) training has been completed by staff.

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. 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

(see next page)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria Reyes	TELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

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: PRUNEDA, DORA FAMILY CHILD CARE	FACILITY NUMBER: 153910711
	VISIT DATE: 06/11/2019

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Licensee was provided a copy of the “Lead Poisoning Facts” brochure. Licensee to refer to PIN 19-04-CCP, for further information. The facility operates Monday through Sunday; 4:00 AM to Midnight.

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

Exit interview was conducted with licensee. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted to parent’s board and must be posted for 30 days.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Gloria Reyes	TELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

LIC809 (FAS) - (06/04)

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