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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911532
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:56:15 PM

Document Has Been Signed on 09/17/2021 02:56 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:ALVA, EVANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543911532
ADMINISTRATOR:ALVA, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-0501
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/17/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Evangelina AlvaTIME COMPLETED:
03:15 PM
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On 09/17/2021 A planned Prelicensing inspection was made today by Licensing Program Analysts (LPAs) Daniel Alvarez and Rene Mancinas, who met with Applicant Evangelina Alva. A tour of the home, inside as shown on the facility sketch was done. Currently the backyard is off-limits to day-care children, prior to use applicant will call her analyst to come clear for day-care use. The areas of the home that day-care children will have access to are the living room, dining room, and hall bathroom. Background clearances were reviewed and verified. The applicant, her husband, three adult children, and one minor child live in the home. The LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPAs observed safe toys, safe indoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and /or cabinets without unsafe items were all observed. Smoke detectors and carbon monoxide detectors and first aid kit are operable and in place. Off-limits rooms are made inaccessible by child safety plastic spinning door knobs. Applicant stated there are no firearms or bodies of waters at the home, nor did LPAs observed these items. CPR, first aid training and health and safety training are current expiring 07/24/2023. Postings, forms, and immunization cards were provided and discussed. LPAs discussed the practice of fire and disaster drills at least every 6 months and to document the date, time and number of children present. Applicant does have two small size dogs that will be inaccessible to day-care children. Applicant is aware of child safety around pets and accepts responsibility for any actions taken by pets. Fact Sheet for Assembly Bill 633 - Child Care Parent Notification Requirements was discussed and copies were provided to applicant - (Fact Sheet and LIC 9224 -Acknowledgement of Receipt of Licensing Reports), The current LIC 995A (12/06) Notification of Parent's Rights and Pub 394 (12/06) -Notification of Parents Rights poster were also provided.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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: ALVA, EVANGELINA FAMILY CHILD CARE
FACILITY NUMBER: 543911532
VISIT DATE: 09/17/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

The home has been given fire clearance by the Fire Department with jurisdiction to the facility, and has forwarded documentation to CCL.

Before Licensure the following items are to be corrected within 30 days to avoid the application form being withdrawn:

1. Applicant needs to either removed all hazardous items in the bathroom, or put them out of children's reach.

2. Applicant needs to install a child safety gate to make her kitchen off-limits to day-care children.

Pending verification of corrections and a final review of your application, licensure as a Large Family Child Care Home capacity of 14 children* ages under 18 years, will be recommended. Planned hours of operation are Monday through Friday from 6:30AM - 6:30PM and as arranged.

A copy of this report is to remain in the facility for public review.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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