Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243903395
Report Date: 02/28/2018
Date Signed 02/28/2018 01:01:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
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: 3DATE:
02/28/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria VazquezTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Robert Gutierrez conducted an unannounced annual/random visit. LPA met with Licensee Maria Vazquez. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Two dogs were observed during today’s visit; licensee is aware of the safety of children around animals. Licensee stated these dogs are inaccessible to children in care. There are no "bodies of water" or firearms in this home. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone (209) 382-1125 and number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunization's for the children. Licensee maintains documentation of immunization's for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). 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. 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. Pediatric CPR/First Aid are current. 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. Days and hours of operation are Monday – Friday; 5:00 AM – 5:30 PM.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2018
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: VAZQUEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243903395
VISIT DATE: 02/28/2018
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LPA discussed Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements.

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

LPA & licensee discussed the Community Care Licensing website and Mandated Reporter Training: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.


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



THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2018
LIC809 (FAS) - (06/04)
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