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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911602
Report Date: 09/21/2021
Date Signed: 09/21/2021 12:52:32 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:DUTRA, TAYLOR FAMILY CHILD CAREFACILITY NUMBER:
503911602
ADMINISTRATOR:DUTRA, TAYLORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 988-9401
CITY:WATERFORDSTATE: CAZIP CODE:
95386
CAPACITY:14CENSUS: 0DATE:
09/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Taylor DutraTIME COMPLETED:
01:00 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On September 21, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Taylor Dutra for a pre-licensing inspection. Applicant, her husband and three minor children reside in the home. Verified licensee CPR and First Aid was completed through American Red Cross and expires on November 16, 2022. Licensee’s Assistant, Elissa Predes completed the CPR and First Aid certification and expires on August 20, 2023. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on August 26, 2021.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on August 26, 2021. Fire alarm is located on the home’s entry way on the right hand side wall.
  • This is a single story, four bedrooms, an office and two bathrooms home and children will have access to the living room, dining room, office (day-care room), bedroom #3 and hallway bathroom. Off-limits rooms are made inaccessible by the use of key locks.
  • There is a fireplace in the living room that applicant states it will be used during day-care hours. LPA observed a child proof safety gate barricading the fireplace preventing access to the day-care children.
    (Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: DUTRA, TAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 503911602
VISIT DATE: 09/21/2021
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  • LPA observed children size furniture, safe toys, and books for the children. Also observed a flat screen television mounted onto the wall. A high chair in the dining room. There is a parents board that is located on the home’s entry way on the left hand side wall. Children will nap in the day-care room on mats. Infants will nap in a play yards or a crib. Applicant understands she is to supervise children at all times. LPA provide applicant with Individual Sleeping Plan and Safe Sleep handout.
  • Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on August 21, 2021.
  • Knives are stored are stored inside a top kitchen cabinet. Medications are stored inside a hallway cabinet on a top shelf. Cleaning compounds are stored in the inaccessible garage.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There are no bodies of water in the home or premises.
  • Applicant states there are no pets in the home or on the premises.
  • Firearms are stored in accordance with Title 22 Regulations and ammunition is stored separate in accordance with Title 22 Regulations.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.


(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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: DUTRA, TAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 503911602
VISIT DATE: 09/21/2021
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  • Fenced backyard has a cemented and grassed area for the daycare children. There is a swing set that is anchored to the ground. Also observed patio furniture and four patio umbrellas for shade.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on June 22, 2021. Applicant’s assistant completed the training June 22, 2021.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 5:30 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



Licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective September 22, 2021.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
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