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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911639
Report Date: 11/01/2021
Date Signed: 11/01/2021 01:54:38 PM

Document Has Been Signed on 11/01/2021 01:54 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:HAYNES, JILL FAMILY CHILD CAREFACILITY NUMBER:
543911639
ADMINISTRATOR:HAYNES, JILLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 429-4112
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jill HaynesTIME COMPLETED:
02:30 PM
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On 11/01/2021 A planned Change of Location/Pre-licensing inspection was made today by Licensing Program Analyst (LPA) Rene Mancinas, who met with Licensee, Jill Haynes. This is single-story home. A tour of the home, inside and outside, as shown on the facility sketch was done. The areas of the home that day care children will have access to are the living room, dining room, kitchen, one bedroom, hall bathroom, and a portion of the backyard (i.e. playard). Licensee and her son are the only adult residents at this home. Background clearances were reviewed and verified. The LIS 536 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPA observed safe toys, safe indoor and outdoor play areas, child safety latches on cabinets and/or cabinets with hazardous items, and a clean and orderly home were all observed. Fire extinguisher, 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 or other child safety devices. There are no firearms at this home. There are no bodies of water at the home, nor did LPA observed this item. CPR, first aid training and health and safety training are current expiring 10/12/2023. Postings, forms, and licensing information were provided and discussed. LPA discussed the practice of fire and disaster drills at least once every 6 months and to document the date, time and number of children present. There are pets at this home. Licensee understands responsibility of any action taken by pets involving day care children.

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. 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

(Continued on 809-C)
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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: HAYNES, JILL FAMILY CHILD CARE
FACILITY NUMBER: 543911639
VISIT DATE: 11/01/2021
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to fourteen children. Pending a final review of your application, licensure as a Large Family Child Care Home capacity of fourteen children* ages under 18 years, will be recommended effective 11/02/2021. Planned hours of operation are Monday through Friday from 07:00AM - 05:30PM, 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: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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