223910193-10-17-2019-04-CC-CROZ-BH2PJX-20191017112217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 223910193
Report Date: 10/17/2019
Date Signed: 10/17/2019 11:22:24 AM

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:	MATTHEWS, ANA FAMILY CHILD CARE		FACILITY NUMBER:	223910193
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Ana Matthews		TIME COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced annual inspection. LPA was greeted by Licensee Ana Matthews who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present was Licensee’s sister, who is also finger print cleared. Present during today’s inspection were six (6) children, including 2 (two) infants. The areas of the home that are accessible to the day care children are the living room, play room, kitchen, dining room, and hall bathroom. “Off-limits” rooms are made inaccessible by door knob spinner. One pet was observed inside during today’s inspection. Three pets were observed outside. Licensee is aware of the safety of children around animals. There are no bodies of water on site. No poisons were observed during today’s inspection. The fireplace is made inaccessible by safety gate. There is a working fire extinguisher, smoke detectors, and carbon monoxide detector. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the 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 backyard 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 maintains documentation of immunizations for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time at least every six months. The last fire drill was completed on 09/30/2019. 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. 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. (Continued on LIC 809C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: MATTHEWS, ANA FAMILY CHILD CARE	FACILITY NUMBER: 223910193
	VISIT DATE: 10/17/2019

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Pediatric CPR/First Aid are current expiring on 06/15/2021. 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 advanced notice.

Days and hours of operation are Monday – Friday; 6:00AM to 9:00PM.

Incidental Medical Services (IMS) are currently being provided for two children. LPA reviewed storage of medication and equipment/supplies and reviewed children’s records. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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