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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503607069
Report Date: 12/17/2019
Date Signed: 12/17/2019 12:03:13 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:FORD, KIMBERLY & KEVIN FAMILY CHILD CAREFACILITY NUMBER:
503607069
ADMINISTRATOR:FORD, KIMBERLY & KEVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 535-7872
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:14CENSUS: 10DATE:
12/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee Kimberly FordTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced annual inspection. LPA was greeted by Licensee Kimberly Ford who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999) provided. Also present were Licensee Kevin Ford and fingerprint cleared assistant Christine Ford. Present during today’s inspection were 10 children. The areas of the home that are accessible to the daycare children are the daycare room, living room, dining room, kitchen, laundry room, four bedrooms, three bathrooms, and fenced backyard. There is a working alarm on the door leading from the daycare room into the garage. During today’s inspection, LPA observed the bedroom at the front of the house, which was made “off-limits” during the annual inspection on 12/05/18 was emptied and contained a play yard. Licensee stated the bedroom is being used for napping of daycare children. LPA thoroughly inspected the bedroom and observed it to be safe with no hazardous items present. Licensee understands that prior to making any changes to rooms that are previously “off-limits” to an area that care and supervision will be provided, Licensee must notify Community Care Licensing (CCL) and the area must be inspected for safety. The bedroom is licensed for daycare use as of this date. The facility sketch was updated and signed by the Licensee. One large dog and one cat were observed during today’s inspection; Licensee is aware of the safety of children around animals. There are no "bodies of water" in this home. Licensee stated there are no firearms in this home. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by glass screen. There is a working fire extinguisher, which was last serviced on 04/02/2019. LPA tested the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

There is a working telephone and cellphone number was verified. Adequate supervision is being provided during this inspection. Children are supervised when outside in the fenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. (Continued on next page, LIC809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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: FORD, KIMBERLY & KEVIN FAMILY CHILD CARE
FACILITY NUMBER: 503607069
VISIT DATE: 12/17/2019
NARRATIVE
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Licensee maintains documentation of immunizations for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

Pediatric CPR/First Aid are current expiring on 07/14/2020. Mandated reporter certificate was verified and expires 12/15/2020. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Friday; 7:30 AM – 5:30 PM.

This facility provides Incidental Medical Services – IMS. No children currently enrolled requiring IMS. 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



LPA & Licensee discussed the CCL website: LPA and Licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Licensee is already enrolled and receiving PINs through email. LPA thoroughly discussed safe sleep practices and left a copy of “Safe Sleep in Child Care.” LPA provided Licensee with the “Effects of Lead Exposure” brochure with instructions to distribute to all parents/authorized representatives of enrolled children.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is found (see next page, LIC809-D). Licensee was provided a copy of appeal rights. Exit interview was conducted with Licensee Kimberly Ford.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
LIC809 (FAS) - (06/04)
Page: 2 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: FORD, KIMBERLY & KEVIN FAMILY CHILD CARE
FACILITY NUMBER: 503607069
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2019
Section Cited

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Alterations to Existing Buildings or Grounds; (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as
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"off limits" to an area where care and supervision will be provided to children in care. This requirement was not met as evidenced by: Based on observation, an "off-limits" bedroom is being used to provide care and supervision. This poses a potential risk to the health, safety, or personal rights of children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3