Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203904885
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:19:54 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:BECERRA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
203904885
ADMINISTRATOR:BECERRA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-3809
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:14CENSUS: 1DATE:
10/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Guadalupe BecerraTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Annual/Random inspection. LPA met with Licensee Guadalupe Becerra . LPA conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. Accessible areas of the home are the living room, dining room, kitchen, hall bathroom and playroom. The back yard has not been used in almost one year. It is need of clean up and currently off limits. All other rooms in the home are made inaccessible by spinner knob covers. A small dog was observed during today's inspection. There are no "bodies of water". There are no firearms in the home. Licensee was reminded that cleaning compounds, medications and other hazardous items are to be inaccessible to children. There is a fireplace that is covered by a large wall picture. Licensee stated it is not used during daycare hours. There are stairs in the home that are barricaded by the use of a baby/child gate making the upstairs level inaccessible to the children in care. There is a working fire extinguisher, smoke detector, carbon monoxide indicator and adequate heating and ventilation for safety and comfort. There is a working telephone (559) 675-3809 and number was verified. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of influenza for herself. Per Licensee, her physician indicated she does not need any other of the required immunizations due to her age. Fire drills are conducted every six months. Licensee is aware that children are never to be left in parked vehicles. All adults who reside or work in the home have a criminal record clearance or exemption. Licensee verified adults cleared and associated to her home by signing LIS 531. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee’s Pediatric CPR/First Aid expires 10/14/2019. Licensee has not completed AB 1207 Mandated Reporter training. Licensee will complete required training once it is available in Spanish. 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 advance notice. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Friday; 6:00 AM – 6:00 PM and as arranged. Continued on 809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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: BECERRA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 203904885
VISIT DATE: 10/02/2019
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Incidental Medical Services (IMS) policy was discussed. There are currently no children on medications. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website. LPA also discussed safe sleep with Licensee.



Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there were no deficiencies found on today's inspection.

Licensee was provided a copy of this report, as well as form LIC 9213.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
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