203909417-1-29-2020-04-CC-ASLR-BLAV3N-20200129150502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203909417
Report Date: 01/29/2020
Date Signed: 01/29/2020 03:05:06 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:	GUERRA, SUSIE FAMILY CHILD CARE		FACILITY NUMBER:	203909417
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 8	DATE:	01/29/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Susie Guerra		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Annual/Random inspection. LPA met with Licensee Susie Guerra. Also present were Licensee'd husband and adult daughter who acts as her assistant. LPA conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. Accessible areas of the home are living room #1, living room #2, dining room, kitchen, hall bathroom 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. Licensee was reminded that cleaning compounds, medications and other hazardous items are to be inaccessible to children. There are no stairs in the home. There is a gas burning fireplace insert barricaded by glass. 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) 871-8494 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. 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 02/06/21. Licensee completed AB 1207 Mandated Reporter Training on 03/15/18. 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; 6:00 AM – 6:00 AM and as arranged. Licensee understands she can not care for any one child more than 23 hours on any given day. 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: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

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: GUERRA, SUSIE FAMILY CHILD CARE	FACILITY NUMBER: 203909417
	VISIT DATE: 01/29/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed.

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. LPA also discussed safe sleep with Licensee.

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: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

LIC809 (FAS) - (06/04)

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