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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243805730
Report Date: 12/03/2019
Date Signed: 12/03/2019 02:12:00 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:ABC CHILD CAREFACILITY NUMBER:
243805730
ADMINISTRATOR:PERALTA, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 756-0689
CITY:WINTONSTATE: CAZIP CODE:
95388
CAPACITY:14CENSUS: 4DATE:
12/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Norma Peralta - LicenseeTIME COMPLETED:
02:30 PM
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(2) Licensing Program Analyst (LPA), Joseph Pacheco, conducted an unannounced Annual/Random inspection today. LPA met with Spanish speaking Licensee, Norma Peralta, toured the home, and census was taken. Staff were spoken to during visit. There are no "bodies of water" or firearms in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, smoke and carbon monoxide detector, and there is adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the backyard play area. Licensee has a fish tank that is inaccessible to children via being kept in an off-limits area of the home. Licensee is aware of child safety around pets and accepts responsibility for any action taken by pets. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Licensee has a current roster of the children. Fire drills are conducted and documented with the date and time every six months. 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. Pediatric CPR/First Aid are current and expire on 11/8/2020.

Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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



An exit interview was conducted with Licensee. LPA provided Licensee with information regarding providing incidental medical services to children, and some important resources and information links offered on the CDSS website. Lead safety information was provided in accordance with AB 2370, Chapter 676, Statues of 2018.

CONTINUED ON LIC809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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: ABC CHILD CARE
FACILITY NUMBER: 243805730
VISIT DATE: 12/03/2019
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Hours of operation are Monday through Friday, 5:00am – 5:00pm

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
LIC809 (FAS) - (06/04)
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