Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503908818
Report Date: 10/10/2017
Date Signed 10/10/2017 02:16:50 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:PERSHALL, MELISSA FAMILY CHILD CAREFACILITY NUMBER:
503908818
ADMINISTRATOR:PERSHALL, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 869-5900
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 7DATE:
10/10/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melissa PershallTIME 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
An unannounced annual/random inspection conducted today by LPA Alice Juarez. Met with licensee, Melissa Pershall. LPA toured the facility inside and out. Licensee is not currently providing IMS Services to children and does not have plans to do so in the near future. Licensee is aware, that if she plans to care for children needing IMS Services in the future, she must submit plans to CCLD. No firearms or ammunition are in the home. There is an in ground pool which is surrounded with mesh fencing and property line fencing. The gate is self latching, self closing and opens away from the pool. Licensee understands the mesh fencing must remain in place during day care hours. Storage areas for poisons, detergents, cleaning compounds and medications are stored where they are inaccessible to children; and poisons are locked. The licensee stated the fireplace will not be used during day care hours. Fire extinguisher, smoke detector and carbon monoxide detector are operable and in place. The home is kept clean and orderly, with heating and ventilation for safety and comfort. The areas that are accessible to children are the living room, dining room, kitchen, playroom and hall bathroom. 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. The home is two stories and stairs are made inaccessible by using a child proof gate. Off-limit rooms are made inaccessible by using child proof gates. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. The home has a current roster of the children. Licensee documents immunizations and maintains and updates records for children and adults. The home conducts and documents fire/disaster drills at least once every six months. 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. LPA reviewed children’s, personnel, and administrative records. The licensee operates Monday through Saturday: 6:00 AM to 6:00 PM. Facility has one cat and two birds that are inaccessible to the children.
Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Visit Notice to be posted for 30 days. Exit interview was conducted with licensee
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Alice JuarezTELEPHONE: (559) 341-5280
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2017
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 1