103911542-7-26-2021-04-CC-NLOI-C5AU4C-20210726151455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103911542
Report Date: 07/26/2021
Date Signed: 07/26/2021 03:15:07 PM

Document Has Been Signed on 07/26/2021 03:15 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:	MADERO, MICHELLE FAMILY CHILD CARE		FACILITY NUMBER:	103911542
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/26/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Michelle Madero		TIME COMPLETED:	03:30 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	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On July 26, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Michelle Madero for a pre-licensing/change of location inspection. Applicant, her husband and three minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance or exemption. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a single story, three bedrooms and two bathrooms home and children will have access to the living room, family room (day care room), dining room (day care room), kitchen and hallway bathroom. Off-limits rooms are made inaccessible by use of key locks and hood and eye latches. There is no fireplace in the home. LPA observed children size furniture, safe toys, arts and crafts supplies and books for the children. There is a diaper changing table, an infant swing and a rocking chair in the day care room. LPA also observed a flat screen television mounted onto the day care room wall. There is a mini refrigerator/freezer in the day care room. Children will nap in the day care room on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times. Facility has a 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on April 3, 2021. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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: MADERO, MICHELLE FAMILY CHILD CARE	FACILITY NUMBER: 103911542
	VISIT DATE: 07/26/2021

NARRATIVE

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Preventative Health and Safety class was completed on July 24, 2018. Applicant understands that as of July 1, 2020, applicant must complete the Lead Poisoning Prevention Training.
Knives are stored inside a top kitchen cabinet in a knife block, the cabinet is made inaccessible by the use of a child proof magnetic lock. Medications are stored in the master bathroom. Cleaning compounds are stored in the laundry room that is a room made inaccessible by the use of a key lock.
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 are no bodies of water in the home or premises.
Applicant states there are no pets in the home or on the premises.
Applicant states there are no firearms or ammunition. Poisons are kept locked in the garage. There in no entry to the garage from the home. The door to enter the garage is on the side of the home. Applicant states that she will ensure that the door is kept locked during day care hours.
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 restraints and/or car seats for all the children under her care when transporting children.
Fenced backyard has a slide play structure, a Step 2 sand table, a Step 2 water table, tricycles, toddler size basketball hoop, a wooden playhouse and other safe toys for the children. LPA also observed a wooden patio porch for shade. There is a gated area that is kept locked in where LPA observed a large trampoline with a netted enclosure, a barbecue grill, a stand up heater and other miscellaneous items. Applicant will ensure that this area is kept locked during day care hours.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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: MADERO, MICHELLE FAMILY CHILD CARE	FACILITY NUMBER: 103911542
	VISIT DATE: 07/26/2021

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SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on March 10, 2021.
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 7:30 AM to 5:30 PM and as arranged. No overnight care will be provided.

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.

Provisional License for a Small Family Day Care Home capacity of 8 children ages under 18 years will be issued for 90 days, pending receipt of the Lead Poisoning Training certification. Provisional license will be effective July 27, 2021.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

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