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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163911782
Report Date: 05/24/2022
Date Signed: 05/25/2022 08:57:09 AM


Document Has Been Signed on 05/25/2022 08:57 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:SAMS, LATASHA FAMILY CHILD CAREFACILITY NUMBER:
163911782
ADMINISTRATOR:SAMS, LATASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 380-8621
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY:14CENSUS: 0DATE:
05/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Latasha SamsTIME COMPLETED:
12:15 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On May 24, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Latasha Sams for a pre-licensing/ change of location inspection. Applicant is the only adult residing in the home. Verified applicant’s CPR and First Aid was completed through Pediatric Plus with Emergency with Medical Services Authority stickers (EMSA) and expires on June 16, 2023. Applicant’s Assistant, Raya Roland completed the training through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on December 7, 2021. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on April 29, 2022.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on May 23, 2022. Applicant states that fire inspector did not require for her to install a fire pull alarm.
  • This is a single story, five bedrooms and three bathrooms home and children will have access to the living room, dining room, kitchen, bedroom #4, bedroom #5 and hallway bathroom #2 and hallway bathroom #3. Off-limits rooms are made inaccessible by use of plastic door knob covers.
  • Applicant states that the family child care home entrance will be through the home's right side run towards the backyard and into the glass sliding door. LPA observed a parents board located on the wall in the backyard patio.
  • There no fireplace in the home.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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 4


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: SAMS, LATASHA FAMILY CHILD CARE
FACILITY NUMBER: 163911782
VISIT DATE: 05/24/2022
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  • LPA observed in bedroom #4; safe toys, books and a flat screen television mounted onto the wall. Also observed in bedroom #5; children size furniture, a colorful alphabetical area rug and a diaper changing table. Children will nap in bedroom #4 and bedroom #5 on mats. Infants will nap in a crib or play yards. Applicant understands she is to supervise children at all times.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on May 4, 2022.
  • Knives inside a kitchen drawer that is made inaccessible with a magnetic child proof safety lock. Medications are stored inside a top kitchen and in the master bedroom. Cleaning compounds are stored in the cabinet that is located underneath the kitchen sink and the cabinets located underneath the bathroom sinks. They are made inaccessible by the use of magnetic child proof safety lock.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There are no bodies of water in the home or premises.
  • Applicant states there are no pets in the home or on the premises.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are kept on the garage floor but are not under key lock.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: SAMS, LATASHA FAMILY CHILD CARE
FACILITY NUMBER: 163911782
VISIT DATE: 05/24/2022
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  • Fenced backyard has a cemented, artificial turf and rubber mulch area for the children to play. There are child size table and chairs, two picnic benches, a soccer net, a tricycle, a small bicycle, balls, and a basketball hoop. LPA also observed a white canopy for shade, patio furniture, two barbecue grills that are covered and two standing patio heaters that are covered.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on June 7, 2021. Applicant’s Assistant completed the training on June 11, 2021.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 6:30am to 5:00pm and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SAMS, LATASHA FAMILY CHILD CARE
FACILITY NUMBER: 163911782
VISIT DATE: 05/24/2022
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Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
  • Applicant will store all poisons under key lock. During inspection, LPA observed Round Up container, Hot Shot container and two Raid bug spray containers.

Pending verification of corrections of the above items and a final review of her application, licensure as Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4