243807756-5-30-2023-04-CC-MDHO-CSBTU5-20230530150147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243807756
Report Date: 05/30/2023
Date Signed: 05/30/2023 03:01:53 PM

Document Has Been Signed on 05/30/2023 03:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GANN, ANGELICA FAMILY CHILD CARE		FACILITY NUMBER:	243807756
ADMINISTRATOR:	GANN, ANGELICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 489-8944
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	14	CENSUS: 4	DATE:	05/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Angelica Gann		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	On 05/30/23, Licensing Program Analyst (LPA) Martha De Haro, conducted an unannounced Annual Required Inspection and was met by Licensee, Angelica Gann. The home has working telephone service and LPA confirmed the phone number is (209) 489-8944. Licensee’s hours of operation are Monday through Friday, 8:00 am to 5:00 pm. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen/dining room, family room, and hall bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic door spinners or baby gates. This is a two story home and there are stairs in the home. The second floor was made inaccessible by use of a baby gate The outdoor play area is located in the back yard. It is fenced and there are no hazards to children present. There is a swimming pool and a spa. Both had pool covers. Licensee’s assistant walked across the pool cover. There are no firearms and ammunition in the home. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is one fireplace in the family room but it is blocked by furniture and not being used. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. There are 2 dogs in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment (cont. on LIC 809-C).

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GANN, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 243807756
	VISIT DATE: 05/30/2023

NARRATIVE

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were mostly complete. LPA observed that all of the files were missing the Consent for Medical Treatment form (LIC 627). In addition, child #2 was missing immunization records. Licensee agreed to have parents sign the LIC 627 form and to obtain any missing immunization records from the parents. Licensee’s Mandated Reporter Training was completed on 09/01/2022. Licensee’s pediatric CPR/First Aid expires on 5/2025. Licensee assistant’s Mandated Reporter Training was completed on 01/19/2022 and her CPR/First Aid expires on 02/05/2024.

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 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations (cont. on LIC 809-C).

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GANN, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 243807756
	VISIT DATE: 05/30/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

Exit interview conducted and report was reviewed with the licensee Angelica Gann.
A notice of site visit was given and must remain posted for 30 days. Appeal Rights were also given to licensee.

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC809 (FAS) - (06/04)

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