543911709-5-4-2022-04-CC-NLOI-CE4QXZ-20220504123421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911709
Report Date: 05/04/2022
Date Signed: 05/04/2022 12:34:32 PM

Document Has Been Signed on 05/04/2022 12:34 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:	HELO, VALERIE FAMILY CHILD CARE		FACILITY NUMBER:	543911709
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/04/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Valerie Helo		TIME COMPLETED:	12:45 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	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On May 4, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Valeria Helo for a pre-licensing inspection. Applicant, her husband, her adult son, her adult daughter and one minor child 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 or exemption. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a two story, five bedrooms and four bathrooms home and upstairs area will be off-limits to the day-care children. There is no gate at the bottom of the stairs making upstairs area inaccessible. There are four bedrooms and two bathrooms upstairs. Care and supervision will be provided in Bedroom #5 also known as the Mother-in-Law quarters and the bathroom located in the bedroom. Off-limits rooms are made inaccessible by the use of a plastic door knob covers. There is fireplace in the home. LPA observed in the Mother-in-Law quarters; children size furniture, safe toys and books for the children. There is a flat screen television mounted onto the wall. LPA also observed refrigerator and a microwave. Children will nap in Bedroom #5 on mats. Infants will nap on play yard. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: HELO, VALERIE FAMILY CHILD CARE	FACILITY NUMBER: 543911709
	VISIT DATE: 05/04/2022

NARRATIVE

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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.

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 5:00am to 7:00pm 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 make the upstairs area inaccessible to the day care children.
Applicant will complete the Preventative Health and Safety course and provide proof of certification to LPA.

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: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: HELO, VALERIE FAMILY CHILD CARE	FACILITY NUMBER: 543911709
	VISIT DATE: 05/04/2022

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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 American Heart Association and expires on December 1, 2023.
Preventative Health and Safety with Prevention of Lead exposure certification has not been completed.
Knives and cleaning compounds are stored in the inaccessible kitchen. Medications are stored in the upstairs bedroom.
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.
Applicant states there are no pets in the home or on the premises.
Applicant states there are no firearms, ammunition or poisons 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 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 will be inaccessible to the day-care children. Applicant states that children will not have any outdoor play.
SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on April 21, 2022.
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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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