543910182-5-1-2019-04-CC-PMUO-BBRT4H-20190501142357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543910182
Report Date: 05/01/2019
Date Signed: 05/01/2019 02:24:01 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:	INFANTE, ADRIANA FAMILY CHILD CARE		FACILITY NUMBER:	543910182
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	ADRIANA INFANTE		TIME COMPLETED:	02:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced Annual Random inspection was conducted at this Family Child Care Home by LPA Patricia Musso today. A tour of the home and grounds was conducted. Licensee is within capacity limit. Licensee said there were no weapons at the home. Licensee said poisons that are kept here are locked. Licensee understands that weapons and poisons are to be locked and not just inaccessible. Medications/cleaning compounds and other harmful items are stored in inaccessible areas. There is a working fire extinguisher, smoke detector and carbon monoxide detector and first aid kit are in place per regulation. There is adequate heating and ventilation for safety and comfort. Safe toys, safe indoor and outdoor play areas observed. The home has working phones. Off-limit rooms are made inaccessible by plastic door knob cover and baby gates. Outdoor play area is fenced. Discussed children shall be supervised at all times. There are no bodies of water on the premises during this inspection. Licensee has one dog that she said is kept separate from the day care children. Licensee understands that she is responsible for child safety around pets at all times. Licensee is aware that any adults providing care and supervision or living in the home must be background cleared and LIS 531 was signed. Licensee maintains a copy of children's emergency information in children's files. Licensee has taken Mandated Reporter Training. Licensees CPR and First Aid training are current. Fire drills are conducted as required at least every 6 months and documented with date and time. Postings are correct. Hours of operation are Monday through Friday from 7:00 AM to 5:00 PM.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia Musso	TELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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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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: INFANTE, ADRIANA FAMILY CHILD CARE	FACILITY NUMBER: 543910182
	VISIT DATE: 05/01/2019

NARRATIVE

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Licensee is responsible to stay current with regulations and forms through the CCLD web site (www.ccld.ca.gov).
Incidental Medical Services (IMS) policy was discussed and a copy of the Plan Requirements was provided to licensee today. IMS was previously discussed with licensee. Licensee stated she does not administer medication.
LPA verified that immunizations per SB792.
LPA & licensee discussed the Community Care Licensing website and Mandated Reporter Training: LPA and licensee 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.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, there are no deficiencies.
During exit interview LPA observed licensee post the Notice of Site Visit prior to leaving the facility. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia Musso	TELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

LIC809 (FAS) - (06/04)

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