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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163911107
Report Date: 02/12/2020
Date Signed: 02/13/2020 09:23:32 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:VALDIVIESO SANTIAGO, PATRICIA FAMILY CHILD CAREFACILITY NUMBER:
163911107
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
02/12/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Patricia Valdivieso SantiagoTIME COMPLETED:
01:40 PM
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On 2/12/2020, Licensing Program Analysts (LPAs) Kathy Pacheco and LPA Ruby Ocegueda conducted an unannounced Case Management inspection as a 90-day follow-up of initial application and license. LPAs met with Licensee, Patricia Valdivieso Santiago (Spanish speaking), who provided a tour of the home, inside and outside, as shown on the facility sketch. There were no "bodies of water" or firearms in this facility. Poisons, cleaning compounds, medications and other hazardous items were inaccessible to children. There was no fireplace. The fire extinguishers and smoke detectors met State Fire Marshall standards. There was a working carbon monoxide detector. 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 was a working telephone. Adequate supervision was being provided during this visit. There were no animals in the home. 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 as indicated on LIS 531 – Facility Roster. The Licensee and other personnel as specified completed training on preventative health practices including pediatric CPR and first aid; Expires: 10/17/2021. 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. LPAs 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 8:30 AM to 6:00 PM and other hours as arranged.

Per California Code of Regulations, Division 12, Title 22, no deficiencies were 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: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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