543911685-1-18-2022-04-CC-NLOI-CASQDV-20220118110523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911685
Report Date: 01/18/2022
Date Signed: 01/18/2022 11:05:35 AM

Document Has Been Signed on 01/18/2022 11:05 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:	GONZALEZ-SAUCEDO, MIRNA FAMILY CHILD CARE		FACILITY NUMBER:	543911685
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/18/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Mirna Gonzalez-Saucedo		TIME COMPLETED:	11:15 AM

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	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On January 18, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Mirna Gonzalez-Saucedo for a pre-licensing inspection. Applicant, her husband and her three 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 bedrooms and two bathrooms home and children will have access to the living room, dining room, kitchen and hallway bathroom. Off-limits rooms are made inaccessible by use of plastic door knob covers. There is no fireplace in the home. LPA observed children size furniture for the children and flat screen television mounted onto the living room wall. There is a parents board located in the living room. Children will nap in the living room cots. Infants will nap in play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. Facility has 2A10BC 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 9, 2023. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

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: GONZALEZ-SAUCEDO, MIRNA FAMILY CHILD CARE	FACILITY NUMBER: 543911685
	VISIT DATE: 01/18/2022

NARRATIVE

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Preventative Health and Safety with Prevention of Lead exposure certification was completed on December 3, 2021.
Knives and medications are stored inside top kitchen cabinets. Cleaning compounds are stored inside the bottom cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof safety latch.
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 a small dog that is kept in the laundry room that is made inaccessible by the use of a child proof safety latch. The dog is also kept on the gated side run of the home. 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. Poisons are kept locked in a storage cabinet that is located in the garage.
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 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 a sodded and cemented area for the day care children.
SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on October 22, 2023.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

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: GONZALEZ-SAUCEDO, MIRNA FAMILY CHILD CARE	FACILITY NUMBER: 543911685
	VISIT DATE: 01/18/2022

NARRATIVE

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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.

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. She 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 7:00 AM to 5:30 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.

Licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective January 19, 2022.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

LIC809 (FAS) - (06/04)

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