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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911320
Report Date: 09/29/2021
Date Signed: 09/30/2021 01:48:14 PM

Document Has Been Signed on 09/30/2021 01:48 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:SUKENIK, NAOMI FAMILY CHILD CAREFACILITY NUMBER:
243911320
ADMINISTRATOR:SUKENIK, NAOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(217) 607-4902
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
09/29/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Naomi Sukenik - LicenseeTIME COMPLETED:
11:45 AM
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On 9/29/21 an unannounced Post Licensing inspection was conducted by Licensing Program Analyst (LPA) Joseph Pacheco. The purpose of today's inspection was to conduct a post licensing follow-up on the initial pre-licensing inspection that took place on 11/25/20. LPA met with Licensee, Naomi Sukenik. Days and hours of operation are Monday - Friday, 8:00am - 5:30pm. A tour of the facility inside and outside was made. Nine day-care children were present on this date. Also present was Licensee's Assistant. The accessible areas of the home are the family room, kitchen, play room, hall bathroom and backyard. Off-limit rooms are made inaccessible by use of locks. Fire extinguisher, smoke alarm and carbon monoxide detector are in place. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee’s CPR and first aid training expires 8/8/22. Licensee’s AB 1207 Mandated Reporter training was completed on 7/5/20. Licensee is aware that a child's roster is to be maintained. LPA reviewed required forms for children's files and staff files. Licensee has pets that are inaccessible to children in care. Licensee is aware of child safety around pets and accepts responsibility for any action taken by pets.

Incidental Medical Services (IMS) policy was discussed. IMS are 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies were cited today. LIC 9213 Notice of Site Visit form is required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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