Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909382
Report Date: 05/05/2016
Date Signed 05/05/2016 10:38:34 AM

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: 7DATE:
05/05/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Vera HintonTIME COMPLETED:
11:00 AM
NARRATIVE
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(1) An unannounced annual/random visit is made today. A tour of the home, inside and outside, as shown on the facility sketch is provided. Licensee has one dog that has access to day care children. Licensee is aware that constant visual supervision is required when children have access to pets. There are no "bodies of water" or firearms in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children. There is a working fire extinguisher, a smoke detector and carbon monoxide detector. There is adequate heating and ventilation for safety and comfort. 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 play area. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Licensee has necessary information to contact parents in an emergency. 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 CPR/First Aid is expired. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.


Per Chapter 3, Division 12, Title 22 of the California Code of Regulations the following deficiencies are cited at this visit. See 809D.


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: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Rusty WilsonTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2016
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: HINTON, VERA FAMILY CHILD CARE
FACILITY NUMBER: 503909382
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2016
Section Cited
102416(c)
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102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. Licensees cards have expired. This is a potential threat to child safety.
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Licensee agreed to mail copies of new cards to Licensing Office by plan of correction due date of 6/3/2016.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Rusty WilsonTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2