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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911749
Report Date: 03/03/2022
Date Signed: 03/03/2022 12:33:03 PM


Document Has Been Signed on 03/03/2022 12:33 PM - It Cannot Be Edited

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:MEJIA, REBECCA FAMILY CHILD CAREFACILITY NUMBER:
543911749
ADMINISTRATOR:MEJIA, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 731-9045
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:14CENSUS: 0DATE:
03/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rebecca MejiaTIME COMPLETED:
12:45 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On March 3, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Rebecca Mejia for a pre-licensing/ change of location inspection. Applicant, her Fiance, her adult son and two minor children reside in the home. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on March 2, 2022.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • This is a single story, four bedrooms and two and a half bathrooms home and children will have access to the living room (day care room and hallway bathroom. Off-limits rooms are made inaccessible by use of a plastic door knob cover and a child proof gate. Fire alarm is located on the home’s entry way on the left hand side wall.
  • There is a fireplace in the family room that applicant states it will not be used during day-care hours.
  • LPA observed in the day care room, children size furniture, safe toys, and books for the children. Children will nap in day care room on mats. Infants will nap in play yards. There are two high chairs. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: MEJIA, REBECCA FAMILY CHILD CARE
FACILITY NUMBER: 543911749
VISIT DATE: 03/03/2022
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  • Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on February 2, 2023. Applicant’s Assistant, Manuela Rodriguez completed her Pediatric CPR and First Aid training through American Safety and Health Institute and expires on July 9, 2023.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on December 14, 2019. Certificate of Lead Poisoning Prevention was completed on February 16, 2022.
  • Knives are stored inside a top kitchen cabinet. Medications are stored in the inaccessible master bathroom. Cleaning compounds are stored in the inaccessible laundry room.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There is an in-ground pool that is fenced with black mesh fencing in accordance with Title 22 Regulations. The gate is self-latching/self-closing, swings away from the pool and latching device is located no more than six inches from the top of the gate. Applicant states there are no pets in the home or on the premises.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are kept locked in a storage area in the garage.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
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: MEJIA, REBECCA FAMILY CHILD CARE
FACILITY NUMBER: 543911749
VISIT DATE: 03/03/2022
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  • Fenced backyard will be inaccessible to the day care children. Applicant will ensure that the doors leading to the backyard are kept locked during day care hours. Applicant states that she will be walking the day care children to a nearby neighborhood park for outdoor play. Applicant understands that she must have 100% visual supervision of the children at all times when playing in an outdoor unfenced area.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on January 26, 2022. Applicant’s assistant completed the training on January 24, 2022.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 6:00 PM and as arranged.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



Licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective March 7, 2022.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
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