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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223909397
Report Date: 08/26/2019
Date Signed: 08/26/2019 02:55:52 PM

COMPREHENSIVE INSPECTION
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:NEILSON, ELISSIE FAMILY CHILD CAREFACILITY NUMBER:
223909397
ADMINISTRATOR:NEILSON, ELISSIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 742-4995
CITY:MARIPOSASTATE: CAZIP CODE:
95338
CAPACITY:14CENSUS: 9DATE:
08/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Elissie NeilsonTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Candis Rodriguez and Robert Gutierrez conducted an unannounced annual inspection. LPAs met with Licensee, Elissie Neilson. Also present was one assistant, Pauline Reynoso. Assistant's CPR/First Aid certification, and immunizations were verified and current. There are two dogs at this home, which are kept outside in a fenced area away from the children. There are no firearms or ammunition at this home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There is no fireplace in this home. There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the fenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that children are never to be left in parked vehicles. All individuals residing at the home have criminal background/fingerprint clearances. 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. Pediatric CPR/First Aid are current and expire in 01/2021. 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. During inspection, LPAs inspected areas where infants sleep. LPAs informed Licensee of Safe Sleep practices for infants and how to provide Safe Sleep environments. LPAs informed Licensee to visit the Department’s website (www.ccld.ca.gov) for updates and changes related to licensing regulations and procedures.

Hours of operation are Monday – Friday 06:00am – 6:00pm, unless otherwise arranged.

(Continued on 809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
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: NEILSON, ELISSIE FAMILY CHILD CARE
FACILITY NUMBER: 223909397
VISIT DATE: 08/26/2019
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LPAs & licensee discussed the Community Care Licensing website and Mandated Reporter Training: LPAs and licensee 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. LPAs left a copy of A Child Care Provider’s Guide to Safe Sleep.

Licensee does not currently care for any children required to have an Incidental Medical Services (IMS) Plan. 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. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited today.

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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
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