243910939-5-13-2019-04-CC-NLOI-BC5U8T-20190513152203

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243910939
Report Date: 05/13/2019
Date Signed: 05/13/2019 03:22:15 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:	INIGUEZ, LILI FAMILY CHILD CARE		FACILITY NUMBER:	243910939
ADMINISTRATOR:	INIGUEZ, LILI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 600-9743
CITY:	MERCED	STATE: CA	ZIP CODE:	95348
CAPACITY:	14	CENSUS: 0	DATE:	05/13/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Lili Iniguez		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Lili Iniguez for a pre-licensing/ change of location inspection. Applicant, her husband, two adult children and one minor child reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a two story, five bedrooms and three bathrooms home and upstairs area will be off-limits to the day-care children. One bedroom is downstairs which will be inaccessible to the day care children by the use of a key lock/ plastic door knob spinner. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in living room, family room, kitchen, and downstairs bathroom. There is a fireplace in the family room that applicant states it will not be used during day-care hours. LPA observed children size furniture, safe toys and books for the children. Children will nap in the living room and family room on cots. Infants will nap inside a play yard. Applicant understands she is to supervise children at all times. Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with EMSA certified stickers. Certification is current and expires on March 2, 2020. Preventative Health and Safety class was completed on May 10, 2019. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

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: INIGUEZ, LILI FAMILY CHILD CARE	FACILITY NUMBER: 243910939
	VISIT DATE: 05/13/2019

NARRATIVE

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Knives are stored inside a top kitchen cabinet that is located on top of the kitchen's range hood, inaccessible to the day care children. Medications are stored in the upstairs master bathroom which is a room inaccessible to the day care children.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
There are no bodies of water in the home or premises.
There is a 10 gallon aquarium with three small turtles and there is a 3 gallon fish tank both with tight fitted lids that are kept in the family room. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
Applicant states there are no weapons, firearms or ammunition in the home or premises. Poisons are stored inside a locked cabinet in the garage.
Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
Applicant states the home is smoke-free.
Applicant states she will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Fenced backyard has a cemented area that is fenced as a designated area for the children to play. There is a wooden porch for shade. LPA observed children size chairs and a table. There are four tricycles for the children and other safe toys.
SB 792 immunizations verified and on file.
Applicant agrees to complete the Mandated Reporter Training when it’s available in Spanish. The required training will be available at www.ccld.ca.gov.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.

(Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

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: INIGUEZ, LILI FAMILY CHILD CARE	FACILITY NUMBER: 243910939
	VISIT DATE: 05/13/2019

NARRATIVE

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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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 5:00 AM to 6:00 PM and as arranged. No overnight care will be provided.

Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.

Applicant agrees to provide Fresno Regional Office with a copy of the family child care home’s indoor/outdoor facility sketch with length and width measurements.

Pending verification of corrections, the above items and a final review of her application, temporary licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.
* Pending a granted fire inspection of the family child care home, licensure as a Large Family Child Care Home capacity of 14 children ages under 18 years will be recommended.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

LIC809 (FAS) - (06/04)

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