Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203809807
Report Date: 08/09/2018
Date Signed: 08/27/2018 04:16:15 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:GUERRERO - MENDEZ, ARACELI FAMILY CHILD CARE HOMEFACILITY NUMBER:
203809807
ADMINISTRATOR:GUERRERO - MENDEZ, ARACELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-8040
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 1DATE:
08/09/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Araceli Guerrero-MendezTIME COMPLETED:
10:50 AM
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(1) An unannounced Required - 3 Year inspection was conducted by Licensing Program Analyst, Patricia Musso today 8/9/18. Licensee was only caring for her granddaughter today.
Licensee is Spanish speaking only. At the beginning of this inspection, licensee called her adult daughter to translate this inspection.
Background clearances were discussed and licensee signed LIS531 indicating adults residing in the home and/or working in the facility have a criminal record clearance and/or have an exemption.

A tour of the facility was conducted and the following was observed and/or discussed:

· Licensee updated her Pediatric CPR and First Aid certification on 7/5/18 but instructor has not yet mailed
the cards to participants.
· This is a one story home.
· A current roster of children in care was observed.
· Facility has a fire extinguisher, working smoke alarm, carbon monoxide alarm, and first aid kit.
· Cleaning products, knifes, and medications are stored out of the reach of children.
· Licensee states there are no poisons in the home or premises. She understands if present they are to be
stored in locked area and inaccessible to children.
· Licensee states there are no weapons in or on the premises.
· There is no fireplace in this home.
· Verified facility has a landline/cell and confirmed phone number.
· The home is clean and orderly and has central heating and air conditioning for comfort.
· Care and supervision is provided in the play, dinning, living and hall bath rooms. Facility has child size
furniture, toys, and games.
· Off-limits rooms are made inaccessible by use of door knob spinners and door locks.
Hours of operation are Monday through Saturday from 4:00 AM to 4:30 PM. Licensee states overnight care is not provided.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2018
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: GUERRERO - MENDEZ, ARACELI FAMILY CHILD CARE HOME
FACILITY NUMBER: 203809807
VISIT DATE: 08/09/2018
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· The licensee understands that children must be supervised at all times.
· There is one small dog in the home. Licensee makes the dog inaccessible to children. Licensee
understands it is her responsibility to keep the children safe from the pets at all times.
· There are no bodies of water in or on the premises. · Fire drills are conducted once every six months (8/2017 & 2/2018). Licensee understands that in addition
to the minimum required (two fire/disaster drills a year) the drills are also to be documented with the date
and time for CCL review.
· Required items were posted on the wall where parents may easily view.
· Backyard contains a wood play structure and additional age appropriate toys for the children. The play
structure needs to be sanded to remove the paint that is peeling off/lifting that can be pulled off.
· Various children’s files were reviewed for emergency information.

Licensing was aware of SB792 immunization requirements and showed LPA her records that show her Tdap 3/29/10, MMR 3/6/18 and Influenza 10/3/17.
Incidental Medical Services (IMS) policy were discussed. Licensee said she does not have any children with the need of medical services. 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. During this inspection
LPA provided licensee the IMS - FCCH Requirement guidelines
Licensee is advised forms and updated information may be obtained on the CCLD website
(www.ccld.ca.gov). She is also advised it is her responsibility to stay current with the regulations.

During the exit interview the licensee was reminded that licensed capacity is not only based on maximum number of children in care, but by ages as well. LPA observed licensee post the Notice of Site Visit prior to leaving the facility. Licensee was advised that the Notice of Site Visit must remain posted for 30 days and retain the evaluation report for 3 years. Licensee is reminded all adults residing and/or working in the home must have a criminal record clearance or exemption (and be associated to facility). Failure to do so will result in a civil a civil penalty in the amount $100 per day for a maximum of $500. The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

In the areas that were evaluated, Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited at the time of the inspection.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2018
LIC809 (FAS) - (06/04)
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