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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500313251
Report Date: 03/15/2021
Date Signed: 03/15/2021 11:15:41 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:MILLER, SHERRIEFACILITY NUMBER:
500313251
ADMINISTRATOR:MILLER, SHERRIE LYNNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 544-1486
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 4DATE:
03/15/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensee, Sherrie MillerTIME COMPLETED:
11:30 AM
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· Confirm operating status, discuss inactive status if applicable

· Confirm days/hours of operation. Open for Daycare-Monday-Sunday- Open 24HRS

· Provider Information Notices – registered to receive PINs? If not, know how to access? Is currently registered with email. Modestorichard@AOL.com

· Facility Roster – is information up to date and current? YES

· Fingerprint clearance – any adults living in the home or regularly present that have not received a criminal record clearance? YES

· CPR/First Aid – is training current and EMSA approved? If not, have they requested a waiver? Currently Valid EXP 11/21

· Mandated Reporter Training (AB1207) – current? Child care provider training required every two years, general training required one time. Available in Spanish. Yes completed and EXP 4/10/21

· Safe Sleep Regulations – Effective 8/19/2020, PIN 20-24-CCP released 9/15/2020 includes link. Yes is currently conducting Safe Sleep Regs

· Fire/Disaster Drills – Has one been conducted within the last 6 months? Best practice to do one every time a new child is enrolled. YES

· Fire/Smoke/Carbon Alarms – functioning properly? YES

· Fire Extinguisher – rating of 2A10BC and fully charged? YES

· COVID 19 technical assistance – RAST tele-inspection completed? Any questions or concerns? Following guidelines? Masks being worn by children? By adults? YES has been completed and no concerns at this time.

· COVID reporting – aware of reporting requirements to CCL and Local PH? Any cases of anyone involved with daycare that haven’t been reported to CCL? Yes, is aware of contact the propers agencies.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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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