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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503910618
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:04:19 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:PACHECO, MARLENE FAMILY CHILD CAREFACILITY NUMBER:
503910618
ADMINISTRATOR:PACHECO, MARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 527-6742
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 9DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marlene PachecoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Claudia Henley conducted an unannounced annual/random inspection #3. LPA met with Licensee and her spouse (assistant). LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A). The rooms accessible to children in care are the living room, dining room, kitchen, hallway restroom and back yard. Off-limits rooms are made inaccessible via plastic door knob spinners. There is one dog on the premises and inaccessible to the children. 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. Fireplace is screened and inaccessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone and number was verified. Adequate supervision is being provided during this inspection. Capacity/ratio as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations for pertussis, measles and influenza for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted 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. Pediatric CPR/First Aid is current and expires 04/03/2020. Mandated Reporter training AB 1207 is current.

Days and hours of operation are Monday – Friday; 5:30 AM – 5:30 PM.

No deficiencies were cited during the visit today. Site Visit Notice posted. Exit interview was conducted.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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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