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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910446
Report Date: 05/20/2022
Date Signed: 05/20/2022 10:24:15 AM


Document Has Been Signed on 05/20/2022 10:24 AM - It Cannot Be Edited

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:DE LA CRUZ, ALICIA FAMILY CHILD CAREFACILITY NUMBER:
163910446
ADMINISTRATOR:DE LA CRUZ, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 717-9494
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: 6DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Alicia De La CruzTIME COMPLETED:
10:40 AM
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On 5/20/22, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual inspection and met with Licensee Alicia De La Cruz. A tour of the home was conducted and a census was taken. Licensee confirmed the day care room, living room, dining room, and hall bathroom are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of spinner knobs and safety gates. There were no firearms on the premises. Swimming pool was fenced per regulation with a gate that is self-latching, self-closing, and opens away from the swimming pool. No windows or doors have direct access to the swimming pool area. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fireplace located in the living room was made inaccessible by a safety gate 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 and there were no hazards to day care children. 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.

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. 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. 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. Licensee's Mandated Reporter Training was completed on 2/19/21. Licensee's pediatric CPR and First Aid expires on 10/9/23. (continued)
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: DE LA CRUZ, ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 163910446
VISIT DATE: 05/20/2022
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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was 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



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 6:30 AM to 5:00 PM and other hours as arranged.

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Alicia De La Cruz.

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

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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