Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153903235
Report Date: 11/29/2016
Date Signed: 11/29/2016 12:47:07 PM

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:TINOCO, TRINDAD FAMILY CHILD CAREFACILITY NUMBER:
153903235
ADMINISTRATOR:TINOCO, TRINIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 854-1723
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 3DATE:
11/29/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Trinidad Tinoco, LicenseeTIME COMPLETED:
01:00 PM
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(2) LPA Pete Espinoza conducted an unannounced annual/random visit. LPA met with Trinidad Tinoco, Licensee, who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. The fire extinguishers and smoke detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone. Adequate supervision is being provided during this visit. Outdoor play areas are fenced or supervised by the licensee or care giver. Capacity as specified on the license is being maintained. (Large FCCH) Staff-child ratios are maintained. There is a current roster of the children. The fire and disaster drills are conducted at least once every six months, and are documented with the date and time of each drill. All adults who reside or work in the home have a criminal record clearance or exemption. The licensee and other personnel as specified have completed training on preventative health practices including pediatric CPR and First Aid; Expires: 12/02/2017.

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:
Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2016
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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