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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908341
Report Date: 06/30/2021
Date Signed: 07/02/2021 01:06:22 PM

Document Has Been Signed on 07/02/2021 01:06 PM - It Cannot Be Edited

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:GAITHER, ANNA FAMILY CHILD CAREFACILITY NUMBER:
103908341
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
06/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anna GaitherTIME COMPLETED:
10:00 AM
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On 06/30/2021 Licensing Program Analyst (LPA), Diane Mercado conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection was Licensee Anna Gaither and Licensee assistant (S1). Licensee, her husband, and two minor children reside in the home. Verified licensee and licensee’s assistant’s CPR and First Aid was completed through American Red Cross and expired on 02/2023. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on June 16, 2021.

A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed:
Fire clearance was received on June 24, 2021. Fire alarm in the hallway between bedroom #2 & bedroom #3.
· LPA observed in the day care room; children size furniture, safe toys and books for the day care children. There is a parent’s board that is located on the left-hand side wall of the home’s entry way.
· Licensee states she does not have weapons, firearms, ammunition or poisons in the home.
· Facility has 3A40BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place.
· Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
· Licensee is advised that smoking is prohibited on the premises of a family childcare 10267777 home as specified in Health and Safety Code Section 1596.795(a). Licensee states the home is smoke-free.



(Continued on LIC809-C):
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2021
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: GAITHER, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 103908341
VISIT DATE: 06/30/2021
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· Licensee states she will be transporting day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
· Required items are posted in the Child Care Home where parents may easily view.
· During visit capacity worksheet was provided and discussed.
· Licensee completed the Mandated Reporter Training on February 26, 2020. Licensee’s Assistant completed the training on November 23. 2020.
· LPA discussed safe sleep regulations and Safe Sleep Regulation Concepts were given to licensee.
· LPA & licensee discussed the Community Care Licensing website: 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.

Licensee states her hours of operation are Monday through Friday from 7:30 AM to 5:30 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

The 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 is adequate for a Large Family Day Care Home (LFDCH). Licensure as a Large Family Day Care Home capacity of 14 children will be recommended effective 06/30/2021.



During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
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