203911920-3-22-2023-04-CC-JYAZ-CQ6PWP-20230322114105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203911920
Report Date: 03/22/2023
Date Signed: 03/22/2023 11:41:19 AM

Document Has Been Signed on 03/22/2023 11:41 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	CERVANTES, ANGELICA FAMILY CHILD CARE		FACILITY NUMBER:	203911920
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/22/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Angelica Cervantes		TIME COMPLETED:	11:45 AM

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 03/22/2023, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Angelica Cervantes for a pre-licensing inspection. Applicant, her husband, her adult daughter, her adult sister and five 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. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: · This is a two story six bedroom, three and a half bathroom home with an additional back bedroom, and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in the living room, dining room, kitchen and downstairs hallway bathroom. Off-limit rooms are made inaccessible by use of lever locks or key locks. · There is no fireplace in the home. · In the living room, LPA observed a flat screen television mounted on the wall, children size furniture, two small plastic slides, a high chair, a play yard, and safe games, toys, and books for the children. Children will nap on mats, Infants will nap in play yards in the living room. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Infant Sleeping Plan and Safe Sleep handout. · Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CERVANTES, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 203911920
	VISIT DATE: 03/22/2023

NARRATIVE

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· Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus Emergency Medical Services Authority stickers (EMSA) and expires on June 21, 2024.
· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on May 19, 2022.
· Knives are stored in a bottom kitchen drawer made inaccessible via safety latch. Medications are stored in a locked storage closet. Cleaning compounds are stored in a bottom kitchen cabinet made inaccessible via 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 are two dogs and one cat that are kept in off-limit areas. 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.
· 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.
· LPA inspected the fenced backyard which will be off limits to the day care children. Fenced backyard has cement and sodded area for the children. Prior to use, Applicant will contact Licensing to come clear backyard for day-care use. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CERVANTES, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 203911920
	VISIT DATE: 03/22/2023

NARRATIVE

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· SB 792 immunizations verified and on file.
· Applicant completed the Mandated Reporter Training on July 2, 2022.
· LPA discussed safe sleep regulations and Safe Sleep Concepts were given to applicant.
· 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 Friday, 24 hours. Overnight care will be provided. “Overnight Care" means care being provided to children anytime between the hours of 6:00 PM and 6:00 AM. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care.

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.

Pending a final review of application file, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective 03/23/2023.

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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