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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911184
Report Date: 06/23/2021
Date Signed: 06/23/2021 11:24:05 AM

Document Has Been Signed on 06/23/2021 11:24 AM - 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:SANDOVAL ELIZONDO, OFELIA FAMILY CHILD CAREFACILITY NUMBER:
103911184
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ofelia Sandoval ElizondoTIME COMPLETED:
11:30 AM
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On 06/23/2021 Licensing Program Analyst (LPA), Rene Mancinas, conducted an unannounced Annual Required Inspection and was met by Licensee, Ofelia Sandoval Elizondo, who is Spanish speaking. LPA provided services in Spanish. This is the first inspection conducted at this facility since being licensed on 08/25/2020. Days and hours of operation are Monday through Friday 05:00am to 05:30pm.

LPA reviewed current facility sketch and LPA toured the home inside. Licensee confirmed that the living room, dining, kitchen, children’s restroom, and backyard are accessible for children to use. All other rooms/areas are off-limits and made inaccessible by use of children safety gate/ child proof devices. There are pets at this home. Licensee understands the responsibility of any action taken by pets involving day care children. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition at this home. No poisons were observed during the inspection.

There is a fireplace at this home that is made inaccessible to children by the use of a safety gate placed around it. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The home has working telephone service and LPA confirmed the phone number is 559-590-8590.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area located on the side of the house is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

(Continued on 809-C)

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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: SANDOVAL ELIZONDO, OFELIA FAMILY CHILD CARE
FACILITY NUMBER: 103911184
VISIT DATE: 06/23/2021
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LPA discussed Safe Sleep Regulations with licensee. Licensee understands she is to physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Pediatric CPR is to expire on 4/17/23. Child Abuse Mandated Reporter Training was completed on 08/01/2020. 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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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