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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911681
Report Date: 01/12/2023
Date Signed: 01/12/2023 11:30:52 AM

Document Has Been Signed on 01/12/2023 11:30 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:ALCAZAR, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243911681
ADMINISTRATOR:ALCAZAR, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 679-2637
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
01/12/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Alcazar - LicenseeTIME COMPLETED:
11:45 AM
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On 1/12/23 Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced Post Licensing inspection. The purpose of today's inspection was to conduct a post licensing follow-up on the initial pre-licensing inspection that took place on 8/10/22. LPA met with Licensee, Maria Alcazar. Also present was Licensee’s assistant. A tour of the facility inside and outside was made. Five day-care children were present on this date. The accessible rooms are the living room, dining room, kitchen, hallway restroom, and the backyard. Off-limit rooms are made inaccessible by use of locks. Licensee’s CPR and first aid training expires 9/10/23. Licensee’s AB 1207 Mandated Reporter training was completed on 8/10/21. Licensee is aware that a child's roster is to be maintained. The required forms are posted. LPA reviewed Safe Sleep regulations, staff-child ratios, required forms for children’s files and required forms for day care staff files. Licensee has one dog that is inaccessible to day-care children. Licensee accepts liability of any action taken by pets.

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. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://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 Title 22, Division 12, Chapter 3 of the California Code of Regulations no deficiencies were cited. This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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