Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909382
Report Date: 06/12/2015 12:00:00 AM
Date Signed 06/12/2015 04:01:24 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:HINTON, VERA FAMILY CHILD CAREFACILITY NUMBER:
503909382
ADMINISTRATOR:HINTON, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 284-7440
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 0DATE:
06/12/2015
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Vera HintonTIME COMPLETED:
04:10 PM
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A planned prelicensing visit for a change of location is made today by LPA Susan Cantrell. Applicant is Vera Hinton. A tour of the home, inside and outside, as shown on the facility sketch is provided. Background clearances are discussed and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. The accessible rooms are the living room, dining room, kitchen, playroom, and hallway bathroom. The off-limit rooms are made inaccessible with child proof devices. Safe toys, safe indoor and outdoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets without unsafe items, and a clean and orderly home are all observed. Operable fire extinguisher, smoke alarm, carbon monoxide detector, and first aid kit are in place. There is no fireplace. There are no firearms or "bodies of water" in this home. There is one dog that is not around day care children. CPR and first aid training are current with an expiration date of 09/2015. Health and safety training is completed and a copy is in the file. LPA discussed the practice of fire drills at least every 6 months and to document the date and time when practiced. The fire clearance was granted on 6/4/15.

Postings and forms are provided and discussed. 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.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of the California Code of Regulations and licensure for a capacity of up to fourteen children is approved. Planned hours of operation are Monday through Saturday, 5:45 am to 6:00 pm.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Susan CantrellTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2015
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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