503911966-6-1-2023-04-CC-JYAZ-CSDUL2-20230601154000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911966
Report Date: 06/01/2023
Date Signed: 06/01/2023 03:40:05 PM

Document Has Been Signed on 06/01/2023 03:40 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	SEGURA, ADRIANA FAMILY CHILD CARE		FACILITY NUMBER:	503911966
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/01/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Adriana Segura		TIME COMPLETED:	03:45 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 06/01/2023, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Adriana Segura for a pre-licensing inspection. Applicant, her husband, and two 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 single story four bedroom, three bathroom home and children will have access to the entryway, play room, and hallway bathroom. Off-limits rooms are made inaccessible by use of key lock and/or safety gates. · There is a fireplace in the living room that applicant states will not be used during day-care hours. · In the playroom, LPA observed children size table and chairs, learning wall art, a small ball pit, wooden cubbies for storage, and safe games, toys, and books for the children. There's also a parent board. Children will nap on mats or cots, Infants will nap on play yards in the play room. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. · Facility has 10B:C fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. · Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on October 4, 2024. · Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on March 22, 2023 · Knives, medications, and cleaning compounds are stored in top kitchen cabinets. The kitchen is made inaccessible via safety gate. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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: SEGURA, ADRIANA FAMILY CHILD CARE	FACILITY NUMBER: 503911966
	VISIT DATE: 06/01/2023

NARRATIVE

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· 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 one dog that is kept in the off-limits garage and one cat that is kept in an off-limits room. 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.
· Fenced backyard has cement sodded area for the children. There is an umbrella for shade. LPA observed a small trampoline, a small plastic slide, a tricycle, and other safe toys for the children.
· SB 792 immunizations verified and on file.
· Applicant completed the Mandated Reporter Training on October 11, 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.

(CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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: SEGURA, ADRIANA FAMILY CHILD CARE	FACILITY NUMBER: 503911966
	VISIT DATE: 06/01/2023

NARRATIVE

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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 from 6:00 am to 6:00 pm and as arranged. No overnight care will be provided.

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 remove protruding nails that are in the backyard fence.
· Applicant will obtain a 2A10BC or bigger fire extinguisher.

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: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC809 (FAS) - (06/04)

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