543907356-3-28-2024-57-CC-JPEE-D3SR9D-20240328124922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543907356
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:49:28 PM

Document Has Been Signed on 03/28/2024 12:49 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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	SEPULVEDA, ELISANDRA FAMILY CHILD CARE		FACILITY NUMBER:	543907356
ADMINISTRATOR:	SEPULVEDA, ELISANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 350-3277
CITY:	POPLAR	STATE: CA	ZIP CODE:	93258
CAPACITY:	14	CENSUS: 1	DATE:	03/28/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Licensee, Elisandra Sepulveda		TIME COMPLETED:	01:15 PM

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On 03/28/2024, Licensing Program Analyst (LPA) Jose Penate, conducted an unannounced Annual Required Inspection and was met by licensee, Elisandra Sepulveda. Days and hours of operation are Monday – Saturday; 4:00 AM – 6:00 PM. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the converted garage daycare room, daycare bathroom in daycare room, and front yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by closed door/gate and plastic doorknob cover. LPA did not observe swimming pools or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters accessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

This is a single level home and there are no stairs. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 559-350-3277.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. 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.

Continued on LIC809-C

SUPERVISOR'S NAME: Gloria Reyes	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SEPULVEDA, ELISANDRA FAMILY CHILD CARE	FACILITY NUMBER: 543907356
	VISIT DATE: 03/28/2024

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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensees Mandated Reporter Training is valid and will expire on 04/10/2025. Licensees and assistants pediatric CPR/First Aid expires on 05/27/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA discussed with licensee that 15 minutes infant sleep log must be completed at the time of physical checks and not at any other time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued on LIC809-C

SUPERVISOR'S NAME: Gloria Reyes	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SEPULVEDA, ELISANDRA FAMILY CHILD CARE	FACILITY NUMBER: 543907356
	VISIT DATE: 03/28/2024

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with licensee, Elisandra Sepulveda. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

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: Gloria Reyes	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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