503608224-6-4-2019-04-CC-TMAZ-BCU6GP-20190604204814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503608224
Report Date: 06/04/2019
Date Signed: 06/04/2019 08:48:19 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:	GREEN, TABATHA FAMILY CHILD CARE		FACILITY NUMBER:	503608224
ADMINISTRATOR:	GREEN, TABATHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 988-5112
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	14	CENSUS: 11	DATE:	06/04/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Tabatha Green		TIME COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Annual inspection and met with Licensee Tabatha Green. Also present were Assistants; Amber Wilkinson, Heather McGreagor and Katelyn Call. LPA Marquez conducted a tour of the home, inside and outside. The rooms accessible to children in care: day care room, an office, bedroom #1 and a hall bathroom. Off-limits rooms are made inaccessible via children’s safety gates. The working telephone number 209-988-5112 was verified.

Two dogs were observed during today’s inspection; licensee is aware of the safety of children around animals. LPA Marquez observed the pets are separated from children by a backyard fence. There are no "bodies of water" or firearms in this home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. The home has a fireplace that is screened. A working fire extinguisher is present. A Smoke detector and carbon monoxide indicator were tested and observed to be operational. There are no stairs in the home. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee has a current roster of the children and maintains documentation of their immunizations. Documentation of immunizations for pertussis, measles and influenza for Licensee and her staff was reviewed today. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Right (LIC995A).

Fire drills are conducted and documented with the date and time every six months. All adults who reside or work in the home have a criminal record clearance or exemption. Pediatric CPR/First Aid is current and expires 08/10/2019. Mandated Reporter training AB 1207 is current and expires 05/09/2020. 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 advance notice.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

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: GREEN, TABATHA FAMILY CHILD CARE	FACILITY NUMBER: 503608224
	VISIT DATE: 06/04/2019

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Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and Notification of Parent’s Rights are posted on the day care room wall.
Days and hours of operation are Monday – Friday; 7:30 AM – 5:30 PM.

LPA & Licensee discussed the Community Care Licensing (CCL) website, newly proposed Safe Sleep regulations, the new additions to the website that include the Provider Information Notifications (PIN), including the Quarterly Updates that informs licensees of new legislation and regulations.

LPA discussed Incidental Medical Services (IMS) and provided Licensee with a copy of the Plan for IMS – Family Child Care Home Requirements (FCCH). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for FCCH Section 102417.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

THE LICENSING FORM (LIC) 9213 NOTICE OF SITE VISIT IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

LIC809 (FAS) - (06/04)

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