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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911455
Report Date: 09/08/2021
Date Signed: 09/08/2021 11:34:29 AM

Document Has Been Signed on 09/08/2021 11:34 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:FLORES, YOLANDA FAMILY CHILD CAREFACILITY NUMBER:
503911455
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/08/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yolanda FloresTIME COMPLETED:
11:40 AM
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On 09/08/2021, Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced post licensing inspection. LPA was greeted by Licensee Yolanda Flores who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present was a fingerprint-cleared live-in adult relative. No children were present during today’s inspection. The areas of the home that are accessible to the daycare children are the living room, kitchen, hallway bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by doorknob spinners.

One dog was present at the home and is kept inaccessible to children; Licensee is aware of the safety of children around animals. There are no bodies of water in this home. Licensee stated there are no firearms in this home. No poisons were observed during the inspection. Detergents, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace has been boarded up and is not in use. There is a working fire extinguisher. LPA tested the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment were observed.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with Licensee. There shall be one crib or play yard for each infant in care, cribs and play yards shall be kept free from all loose articles and objects while infants are sleeping, and there shall be no objects hanging above or attached to the crib or play yard. Infants shall not be swaddled while in care. Infants up to 12 months of age shall be placed on their backs for sleeping. Licensee shall physically check on sleeping infants every 15 minutes and document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants shall be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan shall be completed and in file for each infant up to 12 months of age. (Continued on LIC 809-C)
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2021
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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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: FLORES, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 503911455
VISIT DATE: 09/08/2021
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There is a working telephone and cellphone number was verified. Licensee is aware that children shall not be left in parked vehicles. Children shall be supervised when outside in the play area and there are no hazards to children present. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license shall be maintained.

LPA discussed and provided copies of the documents required to be posted in a visible location at the facility. LPA reviewed a sample of children’s files, which were all complete with emergency information as required. LPA assisted Licensee with identifying the documents required to be maintained in children’s and staff files. Licensee maintains documentation of immunizations for influenza, pertussis, and measles for herself and staff. Licensee’s Pediatric CPR/First Aid are current expiring on 10/23/2022. Licensee’s Mandated Reporter training certificate was completed on 03/30/2021. Licensee understands that a current children’s roster must be maintained and updated as need. Licensee understands that a fire/disaster drill shall be completed at least every six months and documentation shall be maintained with the date and time the drill was conducted. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Friday; 7:00 a.m. – 5:00 p.m.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. An IMS plan will shall be submitted within 30 days. Information regarding Americans with Disabilities 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.
(Continued on LIC 809-C)
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FLORES, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 503911455
VISIT DATE: 09/08/2021
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LPA & Licensee discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms, and Regulations. LPA discussed infant items permitted in Family Child Care Homes and left a visual handout. LPA provided Licensee with the “Effects of Lead Exposure” brochure in accordance with AB 2370, Chapter 676, Statutes of 2018.

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. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC809 (FAS) - (06/04)
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