Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203904637
Report Date: 08/14/2018
Date Signed: 08/14/2018 11:11:38 AM

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:MORENO, MARIA FAMILY CHILD CAREFACILITY NUMBER:
203904637
ADMINISTRATOR:MORENO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 479-8541
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 2DATE:
08/14/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria MorenoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Anna Porter arrived unannounced to conduct an annual 3 year required inspection. Present during the inspection was the licensee and her adult daughter and two children. LPA toured the home, inside and outside, as shown on the facility sketches. There are no bodies of water or firearms in this home. LPA observed one small dog; licensee is aware of the safety of children around animals. There is a fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and for safety and comfort. There are no stairs in the home. The home provides safe toys, play equipment, and materials. Licensee has a current roster of the children. LPA reviewed children’s, personnel, and administrative records. Licensee maintains documentation of immunization's for the children and has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee conducts and documents fire/disaster drills at least once every six months. The licensee has completed training on preventive health practices including pediatric CPR and First Aid. SB 792 (required immunizations) was verified. All adults who reside or work in the home have a criminal record clearance or exemption. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Licensee is aware that children are never to be left in parked vehicles.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Anna J PorterTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2018
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: MORENO, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203904637
VISIT DATE: 08/14/2018
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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. 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

Licensee is advised forms and updated information may be obtained on the CCLD website


(www.ccld.ca.gov). Licensee is also advised that it is her responsibility to stay current with regulations.

Hours of operation are from 3:50 AM to 6:00 PM and as arranged; less than 24 hours.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Anna J PorterTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2018
LIC809 (FAS) - (06/04)
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