503607069-12-15-2021-04-CC-LGAN-C9QSH6-20211215125301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503607069
Report Date: 12/15/2021
Date Signed: 12/15/2021 12:53:12 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 FAMILY CHILD CARE		FACILITY NUMBER:	503607069
ADMINISTRATOR:	FORD, KIMBERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 535-7872
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	14	CENSUS: 13	DATE:	12/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Licensee Kimberly Ford		TIME COMPLETED:	01:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/15/2021, 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 provided. Also present was a fingerprint-cleared live-in adult relative and a fingerprint-cleared assistant. Present during today’s inspection were 13 children. The areas of the home that are accessible to the daycare children are the great room, dining room, kitchen, converted garage, four bedrooms, three bathrooms, laundry room, and fenced backyard. One dog was 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. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by glass door and will not be in use during daycare hours. There is a working fire extinguisher, which was last serviced on 04/22/2021. 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. Safe toys and play equipment were observed. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA observed two infants napping in two separate bedrooms and the doors to the rooms were closed. Both infants woke up when LPA and Licensee entered the rooms. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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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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 FAMILY CHILD CARE	FACILITY NUMBER: 503607069
	VISIT DATE: 12/15/2021

NARRATIVE

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LPA reminded Licensee that the doors to the rooms where infants are sleeping must remain open at all times so that Licensee can see into the room without moving the door.

Adequate supervision is being provided during this inspection. Children are accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. Children are supervised when outside in the play area and there are no hazards to children present. Capacity as specified on the license is being maintained.

There is a working telephone and cellphone number was verified. LPA reviewed a sample of children’s files, which were all complete with emergency information as required. Licensee maintains documentation of immunizations for influenza, pertussis, and measles for herself and staff. Licensee’s Pediatric CPR/First Aid are current expiring on 09/12/2022. Licensee’s Mandated Reporter training certificate was completed on 02/24/2021. 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 a.m. - 5:30 p.m.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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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 FAMILY CHILD CARE	FACILITY NUMBER: 503607069
	VISIT DATE: 12/15/2021

NARRATIVE

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LPA & Licensee discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms, and Regulations. Licensee stated she is receiving PINs and updates through email. LPA discussed infant items permitted in Family Child Care Homes and left a visual handout. LPA provided Licensee with the “Effects of Lead Exposure” brochure in accordance with AB 2370, Chapter 676, Statutes of 2018.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited. Exit interview conducted and report was reviewed with the licensee Kimberly Ford.

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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