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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910950
Report Date: 11/18/2019
Date Signed: 11/18/2019 01:01:11 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:IBARRA, CRISTINA FAMILY CHILD CAREFACILITY NUMBER:
543910950
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Cristina IbarraTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPA) Diane Mercado made a Case Management -Other, 90 day inspection. Toured facility inside and outside, census taken. Purpose of today's visit was to conduct a 90 day follow-up on initial Pre-licensing inspection which took place on 06/25/2019. Reviewed a sample of children files, required forms were in the files. This is a single story home and children will have access to the front yard, living room, dinning room, kitchen, bedroom #3, and hallway bathroom. Off-limits rooms and closets are made inaccessible by use of a key locks or plastic door knob spinners. Licensee has one pet and will be inaccessible to day-care children. Hours of operation are 5:00 A.M to 5:00 P.M Monday through Friday.

LPA also explained the Incidental Medical Services (IMS) for the Family Child Care Home requirements. LPA thoroughly explained the processes and procedures. LPA explained that this procedure must be submitted within the next 30 days, the licensee must submit proof of compliance with the plan of operation as per Title 22, Division 12, Chapter 3 regulations and 102417 (Family Child Care Homes).

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 during todays inspection.

Notice of Site Visit Form 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: 11/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2019
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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