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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910984
Report Date: 07/08/2019
Date Signed: 07/08/2019 03:49:50 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:CERVANTES, CYNTHIA FAMILY CHILD CAREFACILITY NUMBER:
243910984
ADMINISTRATOR:CERVANTES, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 230-2969
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:14CENSUS: 0DATE:
07/08/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Cynthia CervantesTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Cynthia Cervantes for a pre-licensing/ change of location inspection. Applicant, her husband, her Adult Daughter, Melissa Cervantes who will also be her assistant and one minor child reside in the home. Verified licensee and licensee’s assistant’s CPR and First Aid are current. Licensee’s certification was completed through Pediatric Plus with EMSA certified stickers and expires on 6/15/2021. Licensee Assistant’s was complete through Emergency Response for Child Care with EMSA certified stickers and expires on July 14, 2020. 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. Fire clearance was granted on June 13, 2019.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on July 1, 2019. Fire alarm is located on a wall in the family room (day care room).
  • This is a two story, four bedroom and two bathrooms upstairs and ½ bathroom downstairs. 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, family room (day care room), kitchen, dining room and downstairs bathroom.
  • There is a fireplace in the family room (day care room) that applicant states it will not be used during day-care hours.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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: CERVANTES, CYNTHIA FAMILY CHILD CARE
FACILITY NUMBER: 243910984
VISIT DATE: 07/08/2019
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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 10:00 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.
  • There is an in-ground pool that is fenced with white rod iron fencing. LPA observed that the pool gate is not self-latching/self-closing. LPA will conduct a second prelicesing inspection to ensure the gate meets Title 22 Regulations.

Pending verification of corrections, the above items and a second prelicensing inspection. Provisional licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended pending receipt of the Preventative Health and Safety certification.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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: CERVANTES, CYNTHIA FAMILY CHILD CARE
FACILITY NUMBER: 243910984
VISIT DATE: 07/08/2019
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  • LPA observed children size furniture, safe toys, puzzles, games and books for the children. Also observed was a crib, a diaper changing table, a play yard and a parent’s board all in the family room (day care room). Children will nap in the family room (day care room) on cots. Infants will nap on a crib or 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.
  • Knives are stored inside a top kitchen on a top shelf. Medications are stored in an upstairs bedroom closet.
  • 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 two small dogs that are kept in an upstairs bedroom. 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 kept locked.
  • 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 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 cemented and sodded backyard has safe toys, child size furniture, three water 3 tables for the children. There is patio furniture.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on July 12, 2018.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
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