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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203911380
Report Date: 01/12/2021
Date Signed: 01/14/2021 05:27:53 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:BARRAGAN, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
203911380
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
01/12/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Angelica BarraganTIME COMPLETED:
07:45 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 January 12, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Angelica Barragan for a pre-licensing/change of locations and capacity increase inspection. Applicant, her husband, an adult daughter and one minor child reside in the home. Licensee’s Assistant will be her adult Daughter, Alejandra Barragan. 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 December 3, 2020.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on December 14, 2020. Licensee states that fire inspector did not require for her to install a fire pull alarm.
  • This is a single story, four bedrooms and two bathrooms home and children will have access to the living room, dining room, bedroom #1, bedroom #2, bedroom #3 and hallway bathroom. Off-limits rooms are made inaccessible by use of key locks and child proof safety locks.
  • There is a fireplace in the living room that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture safe toys, safe toys, books and instructional materials for the day care children. Children will nap in bedroom #1, bedroom #2 and bedroom #3. Infants will nap in a crib or a play yard. There is a high chair. There is a parents board in the living room. Applicant understands she is to supervise children at all times.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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 3
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: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380
VISIT DATE: 01/12/2021
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  • Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant’s Pediatric CPR and First Aid certification was completed through Emergency Response for Child Care and expired on November 2, 2020.
  • Preventative Health and Safety class was completed on November 16, 2018.
  • Knives are stored inside a kitchen drawer. Medications are stored inside a hallway cabinet that is made inaccessible by the use of a key lock. Cleaning compounds are stored in a locked shed that is located in the backyard.
  • 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.
  • There is a small dog that is kept in the backyard accessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are stored in a locked shed.
  • 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 restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard has a cemented area for the day care children to play. Applicant states that the day care children will also have access to the front fenced yard. LPA observed a wooden swing/slide play structure that is anchored to the ground. There is a Little Tikes toddler basketball hoop and patio furniture. Applicant states that children will also have access to the garage for arts and crafts. There is a Radio Flyer wagon and a Little Tikes picnic table.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380
VISIT DATE: 01/12/2021
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  • SB 792 immunizations verified and on file.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

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. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Saturday, 24 hours and as arranged. Overnight care will be provided. Applicant is advised that she must not care for children more than 24 hours.

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.



Provisional license for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 180 days, pending receipt of the Pediatric CPR and First Aid certification and Mandated Reporter Training certification. Provisional license will be effective January 13, 2021.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC809 (FAS) - (06/04)
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