155620515-8-28-2024-57-CC-NLOI-D8L3LB-20240828182028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 155620515
Report Date: 08/28/2024
Date Signed: 08/28/2024 06:20:37 PM

Document Has Been Signed on 08/28/2024 06:20 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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	PERALTA, ANTONIO FAMILY CHILD CARE		FACILITY NUMBER:	155620515
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/28/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	04:45 PM
MET WITH:	Antonio Peralta		TIME VISIT/ INSPECTION COMPLETED:	06:30 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	On 8/28/24, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Antonio Peralta for a pre-licensing inspection. Applicant and his Mother reside on the property. Applicant's adult female roommate resides in the back house. 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. 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 one and a half bathrooms home and children will have access to the living room (day care room), dining room, kitchen, bedroom #1 (napping room), and hallway bathroom. There is back house that has a living room, kitchen, bedroom and one bathroom. The back house is made inaccessible by fencing and the door to the back house will be kept locked during day care hours. Off-limits rooms/ closets are made inaccessible by use of child proof door knob covers, door knob key code lock and child proof safety gates. There is central air heating/cooling ventilation for safety and comfort. LPA observed in the day care room, child size tables and chairs, safe toys and books for the children. Also observed in the napping room, a play yard, a twin size bed and a diaper changing table. There is a parents board and flat screen television mounted onto the living room wall. There is a high chair in the dining room. Children will nap in the day care room on cots. Infants will nap in bedroom #1 in play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. (Continued on LIC809-C):

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PERALTA, ANTONIO FAMILY CHILD CARE	FACILITY NUMBER: 155620515
	VISIT DATE: 08/28/2024

NARRATIVE

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Facility has 2A10BC fire extinguisher is located in the laundry room area. There is a smoke alarm, carbon monoxide alarm and first aid kit in place.
Applicant’s Pediatric CPR and First Aid certification was completed through EMS Safety with Emergency Medical Services Authority stickers (EMSA) and expires on 1/12/26.
Preventative Health and Safety with Nutrition and Prevention of Lead exposure certification was completed on 3/7/24.
Knives are stored inside a top kitchen cabinet. Medications are stored in an inaccessible bedroom. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof safety latch.
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.
There is a dog that is kept in the backyard accessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
Applicant states there are no firearms or ammunition in the home or premises. Poisons are stored key locked inside a storage shed that is located in the backyard.
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 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):

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PERALTA, ANTONIO FAMILY CHILD CARE	FACILITY NUMBER: 155620515
	VISIT DATE: 08/28/2024

NARRATIVE

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Fenced backyard has a cemented area for the children. There are tricycles, a child size picnic table, child size chairs, a basketball hoop and other safe toys. There is a patio porch for shade. The accessible front fenced yard has a sodded area for the children.
Applicant completed the Mandated Reporter Training on 12/28/23.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Applicant is advised it is her responsibility to read and maintain her facility incompliance with Title 22 Regulations. Title 22 Regulations can be found at www.ccld.ca.gov.
SB 792 immunizations are on file.
Applicant is advised Fresno Community Care Licensing Department has inspection authority and can inspect all rooms in the home, garages and/or separate dwellings on the premises.
Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

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. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Sunday, 24 hours a day. Overnight care will be provided. "Overnight Care" means care being provided to children anytime between the hours of 6 p.m. and 6 a.m. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care.

(Continued on LIC809-C):

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PERALTA, ANTONIO FAMILY CHILD CARE	FACILITY NUMBER: 155620515
	VISIT DATE: 08/28/2024

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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.

Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.

Applicant will make inaccessible the water heater that is located in the laundry room area.
Applicant will make inaccessible the PG & E meter that is located in the backyard.

Pending verification of corrections of the above items and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC809 (FAS) - (06/04)

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