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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910928
Report Date: 03/17/2020
Date Signed: 03/17/2020 11:40:23 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:HERNANDEZ, ROSAURA FAMILY CHILD CAREFACILITY NUMBER:
153910928
ADMINISTRATOR:HERNANDEZ, ROSAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 873-9687
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:14CENSUS: 8DATE:
03/17/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Rosaura Hernandez TIME COMPLETED:
12:00 PM
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Licensing Program Analyst(LPA) Daniel Alvarez met with Licensee Rosaura Hernandez today for an unannounced Required-1 year inspection. A tour and inspection of the home, inside and outside, as shown on the facility sketch is provided. There is a fireplace in the home that will not be used during day-care hours. Background clearances were discussed and the LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. Fire and disaster drills are being conducted and documented at least once every six months. There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. LPA observed safe toys, safe indoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items. Smoke detectors and carbon monoxide detectors, fire extinguisher, and first aid kit are operable and in place. Room that are accessible to day-care children are the entire house. Off-limits rooms are made inaccessible by child safety plastic door knobs and locked doors. CPR, first aid training and health and safety training are current expiring 11/17/2021. Licensee stated there are firearms or bodies of waters at the home, nor did LPA observed these items. Licensee does have one small size dog that will be inaccessible to day-care children. Licensee is aware of child safety around pets and accepts responsibility for any actions taken by pets. A child roster is maintained. Required postings are correct. Day-care hours of operation are seven days a week 24 hours a day with no over 23 1/2 hours of continuous care per a single child.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2020
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: HERNANDEZ, ROSAURA FAMILY CHILD CARE
FACILITY NUMBER: 153910928
VISIT DATE: 03/17/2020
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. 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

LPA 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. 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.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were found during today's inspection.

LIC 9213 Notice of Site Visit form is required to be posted for 30 days.
A copy of this report is to remain in the facility for public review.
This report shall be made available to the public upon request.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2020
LIC809 (FAS) - (06/04)
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