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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543802572
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:23:11 PM

Document Has Been Signed on 07/14/2021 03:23 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:WATERS FAMILY CHILD CAREFACILITY NUMBER:
543802572
ADMINISTRATOR:WATERS, SHARONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 734-1239
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sharon & James WatersTIME COMPLETED:
03:30 PM
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On 7/14/2021, Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced annual inspection and met with Licensee James and Sharon Waters. A tour of the home was conducted, an d a census was taken. Current facility sketch reviewed, and Licensee confirmed the living room, play room, hall bathroom and the bedroom #3 are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of locked doors and a locked glass door.

Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. The fireplace located in the living room was made inaccessible to children by a iron screen and will not be used during day care hours. The fire extinguishers, smoke detectors, and carbon monoxide detector met Community Care Licensing (CCL) regulations. Heating/cooling and ventilation was sufficient for safety and comfort. There were no stairs in the home.

Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained.

LPA discussed Safe Sleep Regulations with Licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping. There are no objects hanging above or attached to the crib or play yard. Infants in care are not swaddled. Licensee was reminded to physically check on sleeping infants every 15 minutes and document any signs of distress, to include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2021
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: WATERS FAMILY CHILD CARE
FACILITY NUMBER: 543802572
VISIT DATE: 07/14/2021
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The outdoor play area in the backyard is fenced and there are no hazards to day care children. Licensee ensures that children in care are supervised at all times. There were no swimming pools, bodies of water, or firearms on the premises. Firearms and ammunition were properly stored and locked separately

A sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee has proof of required immunization (Pertussis/Measles/Influenza) and a written declaration declining flu shot. Licensee's Mandated Reporter Training (MRT) completed on 10/25/2018. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. LPA discussed MRT to be completed by July 30, 2021. Licensee's pediatric CPR and First Aid expires on 3/2022.

Incidental Medical Services (IMS) are not currently 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. 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.

Operating hours are Monday through Friday 7:15 AM to 5:15PM and other hours as arranged.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations no deficiencies were observed today.

An exit interview was conducted with Sharon Waters. Licensee was provided a copy of the Facility Evaluation Report (LIC 809) and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
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