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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543908752
Report Date: 08/05/2019
Date Signed: 08/05/2019 01:21:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, GLORIA FAMILY CHILD CAREFACILITY NUMBER:
543908752
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
08/05/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Gloria Hernandez TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Daniel Alvarez and Diane Mercado conducted a Case Management inspection in regards to increasing capacity. LPAs met with Licensee Gloria Hernandez. A tour of the home, inside and outside, as shown on the facility sketch was done. The areas of the home that day care children have access to are the day-care room/living room, dining room, kitchen and hall bathroom. Off-limits rooms are made inaccessible by child safety plastic spinning door knobs, latches above children's reach and child safety gate. Day care equipment was evaluated. LPA observed a working fire extinguisher, working smoke and carbon monoxide detectors and an adequate first aid kit. During visit, LPA reviewed fire drill log requirements. The home has been given fire clearance by the Fire Department with jurisdiction to the facility, and has forwarded documentation to CCL.

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. 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: http://www.ada.gov/childqanda.htm

The home, grounds and equipment meet Chapter 3, Division 12, Title 22 of California Code of Regulations and adequate for a Large Family Child Care Home. Pending a final review of the application, licensure as a Large Family Child Care Home capacity of 14 children* ages under 18 years, will be recommended.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
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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