243909084-8-19-2021-04-CC-ASLR-C62PZ2-20210819114450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243909084
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:44:56 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:	JARAMILLO, JACQUELINE FAMILY CHILD CARE		FACILITY NUMBER:	243909084
ADMINISTRATOR:	JARAMILLO, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 725-9452
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	14	CENSUS: 0	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jacqueline Jaramillo		TIME COMPLETED:	11:45 AM

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 08/19/21, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced annual inspection and met with Licensee, Jacqueline Jaramillo. A tour of the home was conducted. Current facility sketch reviewed and Licensee confirmed the living room, dining room, breakfast nook, kitchen, and hall bathroom are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of key coded padlocks. There were no swimming pools, bodies of water, or firearms on the premises. There is one small dog. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. There was no fireplace. The fire extinguisher, smoke detector, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. The outdoor play area in the backyard is fenced and there are no hazards to day care children. Licensee ensures that children in care are supervised at all times. Licensee is aware children shall not be left in parked vehicles. There are currently no infants in care. There were no children present during this inspection. Children receiving care at this time are all school age children. A sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee and all employees and/or volunteers have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Licensee's Mandated Reporter Training (MRT) was completed on 03/08/21. All staff had updated MRT Certificates. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee's and staff's pediatric CPR and First Aid expires on 01/31/23.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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: JARAMILLO, JACQUELINE FAMILY CHILD CARE	FACILITY NUMBER: 243909084
	VISIT DATE: 08/19/2021

NARRATIVE

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Incidental Medical Services (IMS) are not currently provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA information line at (800) 514-0301 (voice), (800) 514-0383 (TDD), and website link: https://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, Lead Poisoning Facts, Forms, and Regulations.

Business hours are Monday through Friday 5:00 AM to 6:00 PM and other hours as arranged.

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

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), appeal rights, and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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