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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911851
Report Date: 05/27/2022
Date Signed: 05/27/2022 11:57:59 AM

Document Has Been Signed on 05/27/2022 11:57 AM - 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:GREEN, KARYN FAMILY CHILD CAREFACILITY NUMBER:
153911851
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karyn GreenTIME COMPLETED:
12:00 PM
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On 05/27/2022 A planned Pre-licensing/Change of Location inspection was made today by Licensing Program Analyst (LPA) Diane Mercado, who met with Licensee, Karyn Green. This is a two-story home. A tour of the home, inside and outside, as shown on the facility sketch was done. The areas of the home that day care children will have access to are the day care room, down stairs bathroom, living room, kitchen, dining room, and backyard. The second floor is off limits by children safety gate. Licensee understands she is to notify the Department of any changes regarding accessible/off-limit areas. Background clearances were reviewed and verified. 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-knobs or other child safety devices and children. There are no firearms or ammunition at this home. There are no bodies of water at the home, nor did LPA observed this item. CPR, first aid training and health and safety training are current expiring 06/26/2023. Child Abuse Mandated Reporter Training was completed on 05/04/2022. Lead Poisoning Awareness was completed 06/23/2022. Preventative healthy & safety completed 11/26/2019. Postings, forms, and licensing information were provided and discussed. LPA discussed the practice of fire and disaster drills at least once every 6 months and to document the date, time and number of children present. There are no pets at this home. A fire clearance was granted by fire department with jurisdiction and on file at the Regional Office.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. 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
(Continued on 809-C)

Continued 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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 2
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: GREEN, KARYN FAMILY CHILD CARE
FACILITY NUMBER: 153911851
VISIT DATE: 05/27/2022
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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 8 children. Licensure as a small Family Child Care Home capacity of 8 children* ages under 18 years, will be recommended effective 05/27/2022. Planned hours of operation are 23 hours a day 7 days a week, 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
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC809 (FAS) - (06/04)
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