Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902874
Report Date: 04/27/2017
Date Signed 04/27/2017 01:37:06 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:SHELL, LETICIA FAMILY CHILD CAREFACILITY NUMBER:
153902874
ADMINISTRATOR:SHELL, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 325-6488
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: DATE:
04/27/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee - Leticia Shell TIME COMPLETED:
02:00 PM
NARRATIVE
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LPA Michael Duarte made an unannounced Annual/Random visit. LPA met with licensee, and toured the home. There are no bodies of water on site. No firearms or ammunition are in the home. Storage areas for firearms and other dangerous weapons are inaccessible to children, and locked. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked. There is no fireplace in the home. 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. The home provides safe toys, play equipment, and materials. The licensee is present in the home and ensures that children in care are supervised at all times. Children are not left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment. The home has a current roster of the children. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. 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. There are no excluded individuals in the home. Licensee is aware that upon notice from the Department, any excluded individual/s must be immediately removed from the home and prevented from returning to home or having contact with children in care. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. The licensee and other personnel as specified have completed training on preventive health practices including pediatric CPR and First Aid. Licensee stated her hours of operation are Monday thru Friday from 6:00 AM to 6:00 PM.

Continued on next page. LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2017
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SHELL, LETICIA FAMILY CHILD CARE
FACILITY NUMBER: 153902874
VISIT DATE: 04/27/2017
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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



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

Site Visit Notice posted on the parent board. Exit interview was conducted.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2017
LIC809 (FAS) - (06/04)
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