163909564-3-5-2020-04-CC-KPAO-BMEQ75-20200305105433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163909564
Report Date: 03/04/2020
Date Signed: 03/05/2020 10:54:37 AM

COMPREHENSIVE INSPECTION

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:	KING, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	163909564
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	03/04/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Maria King		TIME COMPLETED:	09:30 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 3/4/2020, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced required one year annual inspection. LPA met with Licensee, Maria King. A tour of the home was conducted and a census was taken. There were no swimming pools or bodies of water on the premises. Firearms and ammunition were properly stored. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fireplace is not used during day care hours. The fire extinguishers, smoke detectors, and carbon monoxide indicator 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. There were three dogs and one cat at the home that do not have access to day care children. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Outdoor play areas were fenced or supervised by the Licensee or care giver. Capacity as specified on the license was being maintained. Children’s records contained all emergency information specified by regulation. 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. The Licensee and other personnel as specified completed training on preventative health practices including pediatric CPR and first aid; Expires: 10/5/2021. Licensee provided proof of required Mandated Reporter Training for herself and staff; Completed: 4/1/2018. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; information regarding Safe Sleep Regulations; AB 2370, Chapter 676, 2018 Statute, requiring child care providers to inform parents and/or guardians with lead safety information, and other information offered on the CDSS website. (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: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

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: KING, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 163909564
	VISIT DATE: 03/04/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Licensee is aware that an IMS plan is required to be submitted to the Licensing office if they provide any of these services.
When any IMS is provided, an updated Plan of Operation that includes 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.

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

Per Title 22 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) 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: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

LIC809 (FAS) - (06/04)

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