Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909306
Report Date: 10/06/2016
Date Signed 10/06/2016 02:13:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:BURCHELL, JULIE FAMILY CHILD CAREFACILITY NUMBER:
103909306
ADMINISTRATOR:BURCHELL, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 486-9031
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:14CENSUS: 11DATE:
10/06/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Julie BurchellTIME COMPLETED:
02:15 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
2) An unannounced Annual/Random visit was conducted today by Licensing Program Analyst, Patricia
Musso. Present during the visit was licensee, licensee's assistants Lia Ghazaryan and Sandeep Kaur and the day care children. 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.
This facility use to provide care for a child of a military parent but no longer has that child enrolled.
A tour of the facility was conducted and the following was observed and/or discussed:
· Verified licensees’ Pediatric CPR and Pediatric First Aid card that has anr expiration date 6/2017.
Licensee said she is also having all her staff attend a Pediatric CPR and First Aid next month.
· This is a one story home.
· A current roster of children in care was observed. Licensee said she is in the middle of updating the
roster.
Licensee will mail a copy of the complete updated version to LPA by Oct 14, 2016.
· 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 showed LPA the one weapon and ammunition she has is properly locked per Title 22 Regulaitons.
LPA went over the regulations of Title 22 regarding the weapons and ammunition.
· There is a fireplace in the living room. Licensee said the fireplace is never used.
· Verified facility has a landline/cell and confirmed phone number.
Licensee said this facility does not and has decided not to provide any IMS for any day care children.
LPA provided licensee with a copy of the SB792. Licensee said she will get and maintain all employees proof of vaccines in their files.
Hours of operation are Monday through Friday from 7:30 AM to 5:30 PM. Licensee states overnight care less than 24 hours is not provided.
An exit interview was conducted with licensee. LPA observed the Notice of Site Visit Form being posted and reminded that it must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: BURCHELL, JULIE FAMILY CHILD CARE
FACILITY NUMBER: 103909306
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2016
Section Cited
102421(b)
1
2
3
4
5
6
7
102421(b) Childs Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7). Licensee is not maintaining the required forms: Consent for Medical Treatment LIC627 and Parents Rights Notice LIC995A for all the day care children.
1
2
3
4
5
6
7
Licensee said she will get the required forms for all her day care children and then will send a statement of what forms she is maintaing for which children.
Licensee will send the above statement to LPA by 10/14/16.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2