Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503602859
Report Date: 05/18/2015 12:00:00 AM
Date Signed 05/18/2015 02:21:45 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:HARLEN, BRENDAFACILITY NUMBER:
503602859
ADMINISTRATOR:HARLEN, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 545-9161
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:14CENSUS: 5DATE:
05/18/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Brenda HarlenTIME COMPLETED:
03:10 PM
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An annual random visit #2 is being conducted by LPA Claudia Henley. I was met by licensee Ms. Harlen and her adult fingerprinted assistant. There were five children present. A tour of the home, inside and outside, as shown on the facility sketch is provided. There are no firearms in this home. There is a spa in the backyard. The vinyl top cover on the spa is locked on all four sides and is within regulation. There is a very small bird pond in the front yard which had no water inside. There is a fish tank indoors which has a cover on top. There is a rabbit in a cage inaccessible to the children. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is not used during day care. There is a working fire extinguisher, a smoke detector and there is adequate heating and ventilation for safety and comfort. The fire/disaster drill was conducted on May 2015. There are no stairs in the home. Safe toys and play equipment are observed. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the fenced play area. There are two dogs on the premises and have access to the children. Licensee is aware of the liability when it comes to the health and safety of the children. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. 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. Pediatric First/Aid & CPR is current on licensee and assistant. Reviewed five children's files today.
The day care hours and days of operation are: Monday through Friday, 7:30 a.m. to 5:00 p.m.

No deficiencies were cited during today's visit.

Site Visit Notice posted on the parent board. Exit interview was conducted.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2015
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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