Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243903395
Report Date: 05/06/2015 12:00:00 AM
Date Signed 05/06/2015 02:47:14 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:VAZQUEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243903395
ADMINISTRATOR:VAZQUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 382-1125
CITY:LEGRANDSTATE: CAZIP CODE:
95333
CAPACITY:14CENSUS: 6DATE:
05/06/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria VasquezTIME COMPLETED:
02:31 PM
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(1) An unannounced annual/random visit was conducted today by LPA Arnold Cortez. Met with licensee Maria Vasquez. A tour and inspection of the home, inside and outside as shown on the facility sketch was conducted. Background clearances were discussed and the LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPA observed safe toys, safe indoor and outdoor play areas, child safety latches on cabinets and/or cabinets without unsafe items, and home was clean and orderly. Smoke alarm, fire extinguisher and first aid kit are operable and in place. The fireplace is screened and not used during day care hours. Rooms that are accessible to day care children are the living room, kitchen/dining area, side bathroom and on bedroom . Off-limits rooms are made inaccessible by child spinning plastic door knobs, and/or latches above child reach. Firearms are locked in an off-limits area. Ammunition is stored and locked separately in an off-limits area not accessible to children. There are no bodies of water on the premises. The family has 2 dogs in their enclosure and are not accessible to family day care children. Licensee is aware of child safety around pets and accepts responsibility for any actions taken by pets. CPR, first aid training, and health and safety training classes are current. Required postings are correct. Children records were reviewed and found to be in compliance. Licensee conducts and documents fire drills. A current roster is on file. Day-care hours of operation are Monday through Friday, 5:00 AM to 7:00 PM.

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

Fact Sheet for Assembly Bill 633 - Child Care Parent Notification Requirements was discussed and copies were provided to applicant - (Fact Sheet and LIC 9224 -Acknowledgement of Receipt of Licensing Reports), The current LIC 995A (12/06) Notification of Parent's Rights and Pub 394 (12/06) -Notification of Parents Rights poster were also provided.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Arnold CortezTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2015
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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