203909173-2-7-2020-04-CC-ASLR-BLKU7V-20200207142033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203909173
Report Date: 02/07/2020
Date Signed: 02/07/2020 02:20:39 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:	D MEDINA DE SANTOS, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	203909173
ADMINISTRATOR:	D MEDINA DE SANTOS, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 661-0669
CITY:	MADERA	STATE: CA	ZIP CODE:	93637
CAPACITY:	14	CENSUS: 3	DATE:	02/07/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Maria D Medina De Santos		TIME COMPLETED:	02:40 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	Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Annual/Random inspection. LPA met with Licensee Maria D Medina De Santos. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight. LPA conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. Accessible areas of the home are the living room, dining room, kitchen, hall bathroom, daycare bedroom and back yard. All other rooms in the home are made inaccessible by spinner knob covers. No pets observed during today's inspection. There are no "bodies of water". There are no firearms in the home. No poisons were observed on the premises. There is no fireplace or stairs in the home. There is a working fire extinguisher, smoke detector, carbon monoxide indicator and adequate heating and ventilation for safety and comfort. There is a working telephone (559) 661-0669 and number was verified. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunization for pertussis, measles and influenza for herself and her assistant. Fire drills are conducted every six months. Licensee is aware that children are never to be left in parked vehicles. All adults who reside or work in the home have a criminal record clearance or exemption. Licensee verified clearances by signing LIS 531. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee’s Pediatric CPR/First Aid expires 09/29/20. Licensee has completed AB 1207 Mandated Reporter Training (MRT) on 03/10/18. Licensee is aware that MRT will need to be retaken in March. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Saturday; 3:00 AM – 6:00 PM and as arranged. Continued on 809-C

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

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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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: D MEDINA DE SANTOS, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 203909173
	VISIT DATE: 02/07/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. No children on medications at this time.

LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there were no deficiencies found on today's inspection.

Licensee was provided a copy of this report, as well as form LIC 9213.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

LIC809 (FAS) - (06/04)

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