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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911066
Report Date: 03/12/2020
Date Signed: 03/12/2020 11:07:24 AM

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:HERRERA, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
503911066
ADMINISTRATOR:HERRERA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 431-3064
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:14CENSUS: 4DATE:
03/12/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth HerreraTIME COMPLETED:
11:20 AM
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On 03/12/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted a Case Management 90-Day inspection. The purpose of the inspection is for LPA to introduce herself to Licensee and discuss any concerns, questions, and up to date information regarding Community Care Licensing (CCL) regulations.

LPA met with Licensee, Elizabeth Herrera, and explained the purpose of the inspection. LPA observed four (4) children in care. LPA toured the facility inside and outside, according to facility sketch. The rooms accessible to children are the living room, family room, kitchen, and hallway bathroom. Off limits areas are made inaccessible by safety gate, door lock, or chain lock. LPA observed safe toys, books, and other items in the living room. LPA observed age appropriate play equipment in the back yard. Licensee stated she supervises the children when playing in the back yard.

LPA reviewed children's files with Licensee, and discussed which licensing forms and documentation are required before accepting children into care. LPA reviewed lead safety information, safe sleep regulations, mandated reporter training, capacity and ratio requirements, and recent Provider Information Notices (PINs) with Licensee. LPA discussed access to PINs, Quarterly Updates, regulations and forms through the CCL website, www.ccld.ca.gov.

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 she provides these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, no deficiencies are cited today. Site Visit Notice posted on parent board. Exit interview was conducted with Elizabeth Herrera.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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