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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500128
Report Date: 12/19/2019
Date Signed: 01/06/2020 09:06:31 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SAINEZ, CHARRONANNFACILITY NUMBER:
394500128
ADMINISTRATOR:SAINEZ, CHARRON ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 784-6276
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:14CENSUS: 0DATE:
12/19/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Charron SainezTIME COMPLETED:
11:00 AM
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This report was amended on 1/6/2020.
Licensing Program Analyst (LPA) Alecia Sifuentes met with applicant, Charron Sainez for a Change of Location inspection. LPA observed no children in care during the inspection. Off limits areas include game room, bedroom #2, bedroom #3, bedroom #4, and laundry room. This is a single story home on a one acre lot. The home has five bedrooms and three baths. Licensee's front and backyard are gated. Licensee understands that 100% supervision is required when children are using the front yard. Licensee has vehicles, motor homes, and trailers parked in the back end of the backyard. Licensee will keep these vehicles locked at all times so that they are inaccessible to children in care. Facility hours of operation are Monday through Friday, 5:30 a.m. to 5:30 p.m.

LPA observed all areas of the home. LPA observed no bodies of water on the property. Toxins and dangerous items were not found. Applicant stated fireplace is locked and will remain inaccessible to children. Applicant provided a copy of the mortgage statement/rental agreement.

Applicant stated there are no weapons in the home. Applicant’s CPR/First Aid certification expires 5/8/2021 and AB 1207 Mandated Reporter certification expired 10/15/2020. All adults in the home have criminal record clearances. A fire clearance was granted by the Lathrop-Manteca FD on 12/18/2019. LPA tested the smoke alarm and carbon monoxide detectors. Fire extinguisher meets Title 22 regulations.

LPA reviewed all required licensing forms which are located in the facility file. Licensee has copies of all required documentation.

Effective, 1/1/2020, LPA is granting a large family child care license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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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