163911009-10-10-2019-04-CC-DQAZ-BGU36W-20191010175902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163911009
Report Date: 10/10/2019
Date Signed: 10/10/2019 05:59:12 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:	CERVANTES, LETICIA FAMILY CHILD CARE		FACILITY NUMBER:	163911009
ADMINISTRATOR:	CERVANTES, LETICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 836-3691
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	14	CENSUS: 0	DATE:	10/10/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	04:50 PM
MET WITH:	Leticia Cervantes		TIME COMPLETED:	06:15 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	A planned Prelicensing inspection was made today by Licensing Program Analyst(LPA) Daniel Alvarez, who met with Applicant Leticia Cervantes. A tour of the home, inside and outside, as shown on the facility sketch was done. 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 living room, dining room, kitchen, great room and hall bathroom. Background clearances were reviewed and verified. Applicant, her husband and 3 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 and outdoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items, and a clean and orderly home were all observed. Fire extinguisher, smoke and carbon monoxide detectors and first aid kit are operable and in place. Off-limits rooms are made inaccessible by children safety plastic spinning door knobs. Applicant stated there are no firearms in this home. There is a in-ground swimming pool located on the premise. CPR, first aid training and health and safety training are current expiring 01/06/2020. 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 not have any 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: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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: CERVANTES, LETICIA FAMILY CHILD CARE	FACILITY NUMBER: 163911009
	VISIT DATE: 10/10/2019

NARRATIVE

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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
The home has been given fire clearance by the Fire Department with jurisdiction to the facility, and has forwarded documentation to CCL.

Before Licensure the following items are to be corrected to avoid the application form being withdrawn:

1. Applicant needs to bring her in-ground swimming pool fence within title 22 regulation regarding accessible bodies of water. Currently there are sections of her pool fencing where there is more than a two inch gap/space between the fence and the ground. Currently the gate is not self latching as well.

Pending verification of corrections and a final review of your application, licensure as a Large Family Child Care Home capacity of up to 14 children* ages under 18 years, will be recommended. Planned hours of operation are Mondays through Friday 7:00 AM to 06:00 PM 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: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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