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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243907490
Report Date: 11/15/2019
Date Signed: 11/15/2019 09:54:16 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:PEREZ, ROSALVA FAMILY CHILD CAREFACILITY NUMBER:
243907490
ADMINISTRATOR:PEREZ, ROSALVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 277-2787
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY:14CENSUS: 3DATE:
11/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosalva PerezTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Ginny Badhesha conducted an unannounced annual inspection and met with Licensee, Rosalva Perez. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside as shown on the facility sketches (LIC 999A). Present in the home was the Licensee, Licensee’s son and three day care children. Fireplace is screened and inaccessible to children in care. Stairs are barricaded when children under age 5 years old are present. LPA observed plenty of age appropriate toys in the day-care room and observed that the house was clean and free of toxins. The knives and medications are stored up high in a cabinet. The chemicals and cleaning supplies are stored in a cabinet under the sink which is always kept locked. The backyard has a fence that goes all around. There was plenty of shade. A dog was observed during today’s inspection; licensee understands responsibility of any action taken by pets involving day care children. The last time Licensee conducted the fire/emergency drills with children was on 06/01/2019. Children's files were reviewed along with the children's roster and everything was completed and up to date. Licensee is current with the immunization requirements per SB 792. Licensee has taken the Mandated Reporter Training AB 1207 on 05/29/2018. Licensees CPR/First Aid certificate expires February 4, 2020. LPA spoke about the safe sleep regulations with Licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure. Licensee has a working fire extinguisher, carbon monoxide and smoke detector. There was adequate heating and ventilation for safety and comfort. Licensee stated that she does not have any guns or ammunition in the home and LPA did not observe any bodies of water during the inspection. There is a working telephone and number was verified. Capacity as specified on the license is being maintained.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services.

(Continued on 809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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 2
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: PEREZ, ROSALVA FAMILY CHILD CARE
FACILITY NUMBER: 243907490
VISIT DATE: 11/15/2019
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Days and hours of operation are Monday through Friday; 6:00am - 5:00pm.

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

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.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC809 (FAS) - (06/04)
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