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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910903
Report Date: 01/22/2021
Date Signed: 01/26/2021 08:21:35 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:MEDINA, MARISOL FAMILY CHILD CAREFACILITY NUMBER:
543910903
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
01/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marisol MedinaTIME COMPLETED:
01:15 PM
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On 01/22/2021 Licensing Program Analyst (LPA) Diane Mercado conducted a televisit via (facetime) due to COVID-19 related matters and as a means of precaution. Purpose of today's telephone inspection was to conduct a follow up virtual tour of an additional room that was added on the side of the house and would like to be used for day care children. Licensee is Spanish speaking and interpreter services were provided by LPA Mercado.

The new room addition is attached on the side of her the house right off the kitchen. There is a wall and sliding glass doors that separate the kitchen and the rest of the house and the new addition room. Building permits and building inspection card were reviewed. Licensee stated the new space will be primarily used for day care services. The new room addition has its own entrance into the room, a restroom located inside, a door leading to the backyard, and a kitchen style sink with counter tops, however no stove or meal heating appliances. Licensee stated she will continue to prep meals/snacks in the main kitchen inside the home, but children will consume the meals/snacks inside the new room addition. Licensee will ensure supervision requirements are met while she preps meals/snacks in the main house. Carbon monoxide and fire alarms were tested and in good working order. Fire extinguisher meeting licensing requirements is readily accessible in the new room addition. Safe toys, furniture, and play equipment were observed. Licensee stated the only areas that will be accessible to day care children is the new additional room and backyard.

The new room addition is deemed safe and available for day care use beginning 01/22/2021.

Per California Code of Regulations Title 22 Division 12 Chapter 3, no deficiency is being cited. Notice of Site Inspection to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2021
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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