543910903-9-19-2019-04-CC-DMEO-BG6THR-20190919144510

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543910903
Report Date: 09/19/2019
Date Signed: 09/19/2019 02:45:15 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:	MEDINA, MARISOL FAMILY CHILD CARE		FACILITY NUMBER:	543910903
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	09/19/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Marisol Medina		TIME COMPLETED:	02:50 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	Licensing Program Analyst (LPA), Diane Mercado and Associate Government Program Analyst (AGPA) Stephanie Navarro, conducted a case management inspection and was met by Licensee, Marisol Medina. Licensee is Spanish speaking and interpreter services were provided by LPA Mercado. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the living room, hallway bathroom, dining room, and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of plastic door spinners. There are no bodies of water or fireplace. The outdoor play area in the backyard is fenced and there are no hazards to children present. There are no firearms or ammunition on the premises. Safe toys and play equipment are observed. Cleaning compounds, medication and other hazardous items are made inaccessible. No poisons were observed during inspection. There are no stairs in this home. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. No pets were observed. Capacity as specified on the license is being maintained. Licensee’s pediatric CPR/First Aid expires on 01/23/2021. LPA discussed with Licensee emergency fire/disaster drill is required to be completed every 6 months. A review of records indicates that immunization records are in file for children and adults. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. 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. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and notification of parent’s rights poster are posted on hallway wall. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Hours of operation are Monday - Friday, 4:00 am to 6:00 pm. Continued 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

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: MEDINA, MARISOL FAMILY CHILD CARE	FACILITY NUMBER: 543910903
	VISIT DATE: 09/19/2019

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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

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