503608001-7-14-2022-04-CC-PZAO-CGBUCH-20220714152757

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503608001
Report Date: 07/14/2022
Date Signed: 07/14/2022 03:28:02 PM

Document Has Been Signed on 07/14/2022 03:28 PM - It Cannot Be Edited

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:	COLLINS, DENISE		FACILITY NUMBER:	503608001
ADMINISTRATOR:	COLLINS, DENISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 577-1627
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	14	CENSUS: 5	DATE:	07/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Denise Collins		TIME COMPLETED:	03:30 PM

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On 07/14/21 Licensing Program Analyst (LPA), Priscilla Zamudio conducted an unannounced Annual Required Inspection and was met by Licensee, Denise Collins. Days and hours of operation are Monday – Friday, 7:30AM – 5:00PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that hallway bathroom, daycare room, living room, kitchen, dining room, office and backyard are used for providing care and are accessible to children. Licensee occasionally uses 3 additional bedrooms for infant napping in play pens. All other rooms are off-limits and made inaccessible by doors being locked. There is no swimming pool or other bodies of water on the premises. There are firearms and ammunition at this home, both are separated from one another locked and in a safe. No poisons were observed during the inspection.

The fireplace located in the living room is made inaccessible by a glass door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (209) 577-1627.

There is a play pen/yard for infant in care. Play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed by licensee, while asleep in the living room. Individual Infant Sleeping Plan is completed for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla Zamudio	TELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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: COLLINS, DENISE	FACILITY NUMBER: 503608001
	VISIT DATE: 07/14/2022

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid is current and will expire 6/5/2023. Mandated Reporter was completed on 7/24/21. There are three dogs in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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 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) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla Zamudio	TELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC809 (FAS) - (06/04)

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