163902876-6-14-2021-04-CC-KPAO-C3YNX7-20210614105041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163902876
Report Date: 06/14/2021
Date Signed: 06/14/2021 10:50:48 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:	DAMON, ANDREA FAMILY CHILD CARE		FACILITY NUMBER:	163902876
ADMINISTRATOR:	DAMON, ANDREA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 375-3716
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 11	DATE:	06/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Andrea Damon		TIME COMPLETED:	10:50 AM

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 6/14/2021, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual inspection and met with Licensee, Andrea Damon. A tour of the home was conducted and a census was taken. All off-limits rooms are made inaccessible by use of spinner knobs. There were no swimming pools, bodies of water, or firearms on the premises. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fireplace is located in the living room and was made inaccessible to children with a glass door and is not used during day care hours. The fire extinguishers, smoke detectors, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. The outdoor play area in the backyard is fenced. Licensee ensures that children in care are supervised at all times. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children. LPA discussed Safe Sleep Regulations with Licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping. There are no objects hanging above or attached to the crib or play yard. Infants in care are not swaddled. Licensee physically checks on sleeping infants every 15 minutes and documents any signs of distress, to include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained. Staff-child ratios were maintained. A sample of children’s records contained all emergency information specified by regulation. (continued on next page)

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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: DAMON, ANDREA FAMILY CHILD CARE	FACILITY NUMBER: 163902876
	VISIT DATE: 06/14/2021

NARRATIVE

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There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee and all employees and/or volunteers have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Although Licensee's assistant has proof of Mandated Reporter Training completed 6/2021, Licensee stated she has not renewed her Mandated Reporter Training. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee's pediatric CPR and First Aid expires on 5/30/2022. .

Incidental Medical Services (IMS) are not currently provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA information line at (800) 514-0301 (voice), (800) 514-0383 (TDD), and website link: https://www.ada.gov/childqanda.htm.

When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding American with Disabilities Act (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 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.

Business hours are Monday through Friday 6:00 AM to 6:00 PM and other hours as arranged.

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

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), Advisory Notes (LIC 9102), and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC809 (FAS) - (06/04)

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