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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163909581
Report Date: 11/12/2019
Date Signed: 11/15/2019 10:25:52 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:BATES, DIANE FAMILY CHILD CAREFACILITY NUMBER:
163909581
ADMINISTRATOR:BATES, DIANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 415-5729
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: 6DATE:
11/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Diane BatesTIME COMPLETED:
02:00 PM
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection. LPA met with Licensee, Diane Bates, who provided a tour of the home, inside and outside, as shown on the facility sketch. The home has a mother-in-law suite that is used for the day care. There are no firearms in the facility. There is an above- ground swimming pool that does not have a ladder accessible, however, it is not fenced. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. The fire extinguishers, smoke detectors, and carbon monoxide indicator meet Community Care Licensing (CCL) regulations. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. There are two dogs in the home that do no 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 has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this inspection. Outdoor play areas are fenced or supervised by the Licensee or care giver. The back yard is currently off-limits to day care children until the Licensee places a fence around the above ground swimming pool. Licensee is aware CCL will need to inspect the back yard play area prior to day care use. Capacity as specified on the license is being maintained. Children’s records contain all emergency information specified by regulation. There are no excluded individuals present at this home. All adults who reside or work in the home have a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary. The Licensee and other personnel as specified have completed training on preventative health practices including pediatric CPR and first aid; Expires: 4/18/20. Licensee provided proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee also provided proof of required Mandated Reporter Training; Completed: 3/1/19.

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.
(continued on next page)
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2019
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: BATES, DIANE FAMILY CHILD CARE
FACILITY NUMBER: 163909581
VISIT DATE: 11/12/2019
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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, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website.

Business hours are Monday through Friday 7:30 AM to 5:30 PM and other hours as arranged.

Per Title 22 of the California Code of Regulations no deficiencies are observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2019
LIC809 (FAS) - (06/04)
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