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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910985
Report Date: 12/18/2019
Date Signed: 12/18/2019 03:57:53 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:ANDERSON, DEBRA FAMILY CHILD CAREFACILITY NUMBER:
543910985
ADMINISTRATOR:ANDERSON, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 824-0326
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 10DATE:
12/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Debra Anderson - Licensee TIME COMPLETED:
04:15 PM
NARRATIVE
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An unannounced annual inspection was conducted today by Licensing Program Analyst(LPA) Jessika Thompson. LPA Thompson met with licensee, Debra Anderson and toured the facility, inside and outside. Present were licensee's assistants and 10 day-care children. The purpose of today's inspection is to conduct a 90 Day follow-up on the pre-licensing inspection that took place on 09/18/19. There are no "bodies of water" or weapons at this residence. Children's files were reviewed and are in compliance. LPA discussed with licensee the requirement of completing fire and disaster drills every six months. Required forms are posted. Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Licensee is aware that forms and updated information may be obtained on the Community Care Licensing Division's website (www.ccld.ca.gov). LPA reviewed with Licensee documentation required in staff files. During today's inspection LPA subscribed licensee to receive updates and Provider Information Notices via email. Reporting requirements were discussed and Licensee understands unusual incidents must be reported the Fresno Community Care Licensing office during the department's normal business hours before the close of the next working day following the occurrence.

Incidental Medical Services (IMS) policy were discussed. Currently, Licensee does not have any children enrolled requiring IMS. Licensee understand that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Facility is operating Monday through Friday, 7:00 AM to 6:00 PM.



Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies are observed today.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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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