153911349-11-5-2020-04-CC-DQAZ-BV3TJK-20201105134628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153911349
Report Date: 11/05/2020
Date Signed: 11/05/2020 01:46:35 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:	HERNANDEZ, NANCY FAMILY CHILD CARE		FACILITY NUMBER:	153911349
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/05/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Nancy Hernandez		TIME COMPLETED:	02:00 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 11/05/2020 A planned Prelicensing inspection was made today by Licensing Program Analyst (LPA) Daniel Alvarez, who met with Applicant Nancy Hernandez. A tour of the home, inside and outside, as shown on the facility sketch was done. This is a two story home with child safety gates located at the bottom of the stairs making the second floor off-limits to day-care children. There is a fireplace in the home that will not be used during day-care hours. The areas of the home that day-care children will have access to are the office, adjacent foyer, and adjacent bathroom. Applicant, her husband, and two minor children live in the home. The LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. 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 were all observed. Fire extinguisher, smoke detectors, carbon monoxide detectors and first aid kit are operable and in place. Off-limits rooms are made inaccessible by child safety gates and child safety door knobs. Applicant stated there are firearms in the home that are kept stored and locked per title 22 regulations in an off-limits room. There is an in-ground pool located at the property that is properly fenced per title 22 regulations. CPR, first aid training and health and safety training are current expiring 09/14/2022. Postings, forms, and immunization cards were provided and discussed. LPA discussed the practice of fire and disaster drills at least every 6 months and to document the date, time and number of children present. Applicant does have one large size dog that will be inaccessible to day-care children. Applicant is aware of child safety around pets and accepts responsibility for any actions taken by pets. Fact Sheet for Assembly Bill 633 - Child Care Parent Notification Requirements was discussed and copies were provided to applicant - (Fact Sheet and LIC 9224 -Acknowledgement of Receipt of Licensing Reports), The current LIC 995A (12/06) Notification of Parent's Rights and Pub 394 (12/06) -Notification of Parents Rights poster were also provided.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q Alvarez	TELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020

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, NANCY FAMILY CHILD CARE	FACILITY NUMBER: 153911349
	VISIT DATE: 11/05/2020

NARRATIVE

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Incidental Medical Services (IMS) policy were 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

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to eight children. Pending a final review of your application, licensure as a Small Family Child Care Home capacity of eight children* ages under 18 years, will be recommended effective 11/09/2020. Planned hours of operation are Monday through Friday from 5:00AM - 5:30PM and as arranged.

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 Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q Alvarez	TELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020

LIC809 (FAS) - (06/04)

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