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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910981
Report Date: 06/27/2019
Date Signed: 06/27/2019 12:00:20 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:BARRIENTOS, ALICIA FAMILY CHILD CAREFACILITY NUMBER:
243910981
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/27/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alicia BarrientosTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Alicia Barrientos for a pre-licensing/ change of location inspection. Applicant and two minor children 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 or exemption.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • This is a two story, four bedroom and three baths home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in the living room #1, living room #2, kitchen, and downstairs bathroom.
  • There is a fireplace in the living room #2 that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture, safe toys, and books for the children. There is a crib and changing table. Also observed was a parent's board. Children will nap in living room #2 on mats. Infants will nap in a crib or 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 card are current and expires on 8/11/2020.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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 3
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: BARRIENTOS, ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 243910981
VISIT DATE: 06/27/2019
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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 8:00 AM to 5:00 PM and as arranged. No overnight care will be provided.

Provisional licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be issued for 90 days pending receipt of updated Preventive Health and Safety Training and proof that the carpet area in living room #1 and living room #2 was cleaned by a professional carpet cleaning service. Applicant agrees to provide LPA proof of service receipt. LPA observed several stains on the downstairs living room #1 and living room #2 carpet. Provisional licensed is effective June 28, 2019.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BARRIENTOS, ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 243910981
VISIT DATE: 06/27/2019
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  • Knives are stored on top the refrigerator. Medications are stored in the upstairs master bedroom.
  • 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 small dog that is kept indoors. 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 in the home or premises.
  • 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 or 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 for the children. LPA observed three tricycles, balls and patio furniture.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on April 27, 2018.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • 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.

(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
LIC809 (FAS) - (06/04)
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