543911607-8-11-2021-04-CC-DQAZ-C5STDG-20210811143819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911607
Report Date: 08/11/2021
Date Signed: 08/11/2021 02:38:29 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:	HOLGUIN, NAOMI FAMILY CHILD CARE		FACILITY NUMBER:	543911607
ADMINISTRATOR:	HOLGUIN, NAOMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 747-4917
CITY:	VISALIA	STATE: CA	ZIP CODE:	93291
CAPACITY:	14	CENSUS: 0	DATE:	08/11/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Naomi Holguin		TIME COMPLETED:	02:45 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	On 08/11/2021 A planned Change of Location/Prelicensing inspection was made today by Licensing Program Analyst (LPA) Daniel Alvarez, who met with Licensee Naomi Holguin. A tour of the home, inside and outside, as shown on the facility sketch was done. The backyard is currently off-limits to day-care children prior to day-care use, Licensee is to call her analyst to come clear her backyard. The areas of the home that day care children will have access to are the living room, bedrooms # 1 & 2, and hall bathroom. Background clearances were reviewed and verified. Only the Licensee lives in the home. The LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPA observed safe toys, safe indoor and outdoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items, and a clean and orderly home were all observed. Fire extinguisher, smoke detectors and carbon monoxide detectors and first aid kit are operable and in place. Off-limits rooms are made inaccessible by child safety plastic spinning door knob, and child safety gate. Licensee stated there are no firearms or bodies of water at the home, nor did LPA observed these items. Postings, forms, and immunization cards were provided and discussed. LPA discussed the practice of fire and disaster drills at least every 6 months and to document the date, time and number of children present. Licensee does have one medium, one large size dog, and one cat that will be inaccessible to day-care children. Licensee is aware of child safety around pets and accepts responsibility for any actions taken by pets.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q Alvarez	TELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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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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: HOLGUIN, NAOMI FAMILY CHILD CARE	FACILITY NUMBER: 543911607
	VISIT DATE: 08/11/2021

NARRATIVE

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Fact Sheet for Assembly Bill 633 - Child Care Parent Notification Requirements was discussed and copies were provided to applicant - (Fact Sheet and LIC 9224 -Acknowledgement of Receipt of Licensing Reports), The current LIC 995A (12/06) Notification of Parent's Rights and Pub 394 (12/06) -Notification of Parents Rights poster were also provided.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to eight children. Pending a final review of your application, Provisionary licensure as a Small Family Child Care Home capacity of eight children* ages under 18 years, will be recommended effective 08/16/2021. Planned hours of operation are Monday through Friday from 7:00AM - 6:00PM and as arranged.

A copy of this report is to remain in the facility for public review.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q Alvarez	TELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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