503910732-6-10-2022-04-CC-PZAO-CF9QUZ-20220610122935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503910732
Report Date: 06/10/2022
Date Signed: 06/10/2022 12:29:41 PM

Document Has Been Signed on 06/10/2022 12:29 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:	DISNEY, TAMI FAMILY CHILD CARE		FACILITY NUMBER:	503910732
ADMINISTRATOR:	DISNEY, TAMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 566-5631
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	14	CENSUS: 12	DATE:	06/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Tami Disney		TIME COMPLETED:	12:45 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 6/10/22, Licensing Program Analysts (LPAs) Priscilla Zamudio and Angelica Slaughter, conducted an unannounced Annual Required Inspection and was met by Licensee, Tami Disney. Days and hours of operation are Monday-Friday 4:30 am-6:00 pm. LPAs toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen, daycare room, living room and hall bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of child safety gates. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. 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. Stairs are fenced or barricaded when children under age 5 years old are present. The home has working telephone service and LPA confirmed the phone number is (209) 566-5631. There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. 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. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 3/19/21. Licensee’s pediatric CPR/First Aid expires on 4/23/23. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla Zamudio	TELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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: DISNEY, TAMI FAMILY CHILD CARE	FACILITY NUMBER: 503910732
	VISIT DATE: 06/10/2022

NARRATIVE

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All adults who reside or work in the home have a criminal record clearance or exemption. 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. Per licensee, there are no excluded individuals present at this home.

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.

Licensee was provided a copy of appeal rights. Exit interview conducted and report was reviewed with Licensee Tami Disney.

This report shall be made available to the public upon request. 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: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC809 (FAS) - (06/04)

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