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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543806639
Report Date: 01/22/2020
Date Signed: 01/22/2020 11:56:50 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:TORRES, JUANA FAMILY CHILD CAREFACILITY NUMBER:
543806639
ADMINISTRATOR:TORRES, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 636-2036
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 2DATE:
01/22/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Juana Torres - Licensee TIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jessika Thompson conducted a case management inspection. LPA met with Licensee Juanna Torres who provided a tour of the home, as shown on the facility sketch. Licensee's home was previously inactive in status. The purpose of the this visit was to inspect the licensee's home to confirm active status readiness. Licensee, her husband, and one adult child live in the home. Off limit areas are made inaccessible by use of spinning doorknob covers. Required forms are posted. Smoke and carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There is a working telephone. The backyard is an off-limit, inaccessible area of the home. Outdoor play takes place in the front yard of home and children are supervised by the licensee or care giver. Licensee has one large dog that occupies the the backyard. Licensee takes full liability for any action taken by family pets. All adults who reside or work in the home have a criminal record clearance. Licensee has current pediatric CPR and First Aid that expires on 06/16/20. Child Abuse Mandated Reporter training was discussed. Licensee is aware of safe sleep concepts for infants in care. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is registered to receive updates via email as of today. Incidental Medical Services (IMS) policy was discussed. Licensee reported that currently she does not have any children enrolled in her day-care. Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department. To order forms, etc. visit our website at www.ccld.ca.gov.

Business hours are Monday -Friday, 7:30 AM to 5:30 PM, and as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were observed today. Active status for this license will commence on 01/22/20.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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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