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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909471
Report Date: 03/12/2020
Date Signed: 03/12/2020 11:27:08 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:BAEZA, ELSA FAMILY CHILD CAREFACILITY NUMBER:
243909471
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elsa Baeza - LicenseeTIME COMPLETED:
12:00 PM
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On 3/12/2020 Licensing Program Analyst (LPA), Joseph Pacheco, conducted an unannounced annual inspection. LPA met with Licensee, Elsa Baeza. There are dogs at this home that are kept in off-limits areas of the home. Licensee is aware of child safety around pets and accepts responsibility for any action taken by pets. There are no firearms or ammunition on the premises. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. There is no fireplace at this home. Fire drills are being conducted and documented at least once every six months. There is a working telephone and number was verified. Adequate supervision is being provided during this inspection. 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 immunization’s for the children. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that children are never to be left in parked vehicles. All individuals residing at the home have criminal background/fingerprint clearances. 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. Pediatric CPR/First Aid are current and expire on 8/24/2021. Licensee’s AB 1207 Mandated Reporter training was completed on 9/9/2019. 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.

Incidental Medical Services (IMS) policy was discussed. 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



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

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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: BAEZA, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 243909471
VISIT DATE: 03/12/2020
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Hours of operation are Monday – Friday, 6:00am – 6:00pm.

An exit interview was conducted with Licensee. LPA provided Licensee with information regarding providing IMS to children. LPA and Licensee discussed the Community Care Licensing (CCL) 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 Safety information, CCL forms and regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies cited 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: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
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