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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 200405989
Report Date: 01/22/2020
Date Signed: 01/22/2020 02:40:29 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:KIDS KARE MADERAFACILITY NUMBER:
200405989
ADMINISTRATOR:FARRIS, SAMANTHAFACILITY TYPE:
840
ADDRESS:1844 SCHNOORTELEPHONE:
(559) 661-2106
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:72CENSUS: 0DATE:
01/22/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Samantha FarrisTIME COMPLETED:
03:15 PM
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On this date, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Annual/Random inspection. LPA met with Director, Samantha Farris. A tour of facility was conducted inside and outside. The following areas are in compliance during this inspection: All floors are clean and safe. Furniture and equipment are in good condition; age appropriate, free of sharp, loose or pointed parts. There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The playground equipment and outdoor activity space is in good condition. Drinking water is available both indoors and outside. Children's toilets and hand washing facilities are in clean, good operating condition. Solid waste storage vessels, including moveable bins, have tight-fitting covers on and are in good repair. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. The facility is in compliance with conditions and limitations specified on the license. Sign in/sign out sheets maintained. No excluded individuals are present at the facility. Facility is in compliance with staff-child ratios and school age sign in/sign out procedures. Incidental Medical Services (IMS) are currently not being provided. IMS policy was discussed. Hours of operation are Monday through Friday from 6:00 am to 6 pm.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Visit Notice posted on the parent board. Exit interview was conducted with Samantha Farris.

Director Samantha Farris provided updated copies of LIC 500 (Personnel Report), LIC 610 (Emergency Disaster Plan) and LIC 308 (Designation of Facility Responsibility) on this inspection.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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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