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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407648
Report Date: 01/23/2020
Date Signed: 01/23/2020 12:22:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:FUENTES, ERIKA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407648
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
01/23/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Erika FuentesTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Elvira Sierra met with applicant Erika Fuentes for the purpose of a Prelicensing inspection visit. Applicant is requesting a license for eight children. Per applicant, the facility will operate Monday-Saturday from 06:00 AM to 06:00 PM. Homes is a single story, 3 bedrooms and 2 bathrooms. All adults residing in the home have a criminal record background clearance file with Community Care Licensing.

Applicant's husband owns the home and the applicant also provided a Landlord Notification, LIC 9151 form. LPA explained the option of obtaining $300,000 liability insurance. Applicant understands that until a policy is obtained, applicant must use the affidavit.
LPA inspected the facility for health and safety hazards and the following was observed; Off-limit areas will consist of; All bedrooms, Bathroom #2 (inside master bedroom), Laundry Room, and back portion of the backyard. Applicant will use a gate/closed doors as a barrier to prevent access to these areas and understands that children may never enter these off-limit areas. Applicant stated there are no weapons in the home. Applicant has a 2:A10BC fire extinguisher, a working dual smoke and carbon monoxide detector in the home. Cleaning compounds, and hazardous materials are inaccessible to children. The backyard is fenced and there are no bodies of water. Applicant understands children must have 100% supervision in unfenced areas. LPA advised applicant that baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. It was discussed that fire drills must be conducted and documented at least every six months, LPA provided applicant with a Fire Drill Log.
Applicant was instructed to contact LPA prior to any new adults living in the home and any major construction or bodies of water are installed or placed on the property. LPA discussed the requirement to get a finger print clearance for all adults residing and working in the home; as wells as a clear TB Test and proof of Immunization.
Report continued on subsuquent page 809C----------------
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) -89-5984
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: FUENTES, ERIKA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407648
VISIT DATE: 01/23/2020
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 Applicant has proof of vaccinated against Measles, Pertussis and Influenza on file with Licensing office. Applicant CPR expired on 08/29/21.

LPA provided the Parent's Rights form/poster and new regulations were reviewed which include seat belt/booster seat laws, Healthy Beverages Act, Immunization laws, smoking prohibition requirements and the new Incidental Medical Services (IMS) policy. 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. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm

Applicant was updated on immunization requirements from the Department of Public Health(CDHP) that were effective July 1, 2019. Additional information and resources can be found on the https://www.shotsforschool.org website.
LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the Applicant can request to be added to the distribution list to receive Quarterly Updates. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

License will be granted pending the following:


- In the backyard area, the following things need to be corrected. Air conditioner needs to be barricaded. Covered the telephone wires outside the home. Install a vent or cover the opening under the house.
-Latches are required for cabinets in the bathroom that are used for storing of toxins.
-Cover the electrical wires in the living room.
-Barricaded the air conditioner grille in the dinning room.

A copy of this report was reviewed and left with applicant.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) -89-5984
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
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