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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911446
Report Date: 04/29/2021
Date Signed: 04/29/2021 03:20:21 PM

Document Has Been Signed on 04/29/2021 03:20 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:PEREZ, YOANA FAMILY CHILD CAREFACILITY NUMBER:
103911446
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Yoana PerezTIME COMPLETED:
03:30 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On April 29, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Yoana Perez for a pre-licensing inspection. Applicant, her husband and three minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • This is a single story, four bedrooms and three bathrooms home and children will have access to the living room and hallway bathroom. The parents/day care children's entrance will be through the home's left side run of the home into the side garage door to the day care room. Off-limits rooms are made inaccessible by use of child proof safety gates.
  • There is a fireplace in the family room that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture, children cubbies, safe toys and books for the day cARE children. There is a colorful-alphabetical area rug, four high chairs, a diaper changing table and a flat screen television mounted onto the wall. Children will nap in living room on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on November 19, 2022.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2021
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 3
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: PEREZ, YOANA FAMILY CHILD CARE
FACILITY NUMBER: 103911446
VISIT DATE: 04/29/2021
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  • Preventative Health and Safety class was completed on February 28, 2018.
  • Knives are stored inside a top kitchen cabinet. Medications are stored inside a top kitchen cabinet and in the refrigerator. Cleaning compounds are stored in the cabinet that is located underneath the kitchen. The kitchen is an area inaccessible to the day care children by the use of a child proof safety gate. Other cleaning compounds are stored in the accessible laundry room inside the cabinet that is located under the sink and made inaccessible by the use of a child proof safety lock.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant 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.
  • There are no bodies of water in the home or premises.
  • There are two dogs, one dog is indoor and kept in an inaccessible bedroom, the other dog will be kept in the home’s gated side run. There is a fish inside a two gallon glass fish bowl that is located in the kitchen. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Firearms are stored in accordance with Title 22 Regulations and ammunition stored separate in accordance with Title 22 Regulations.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard will be inaccessible to the day care children. LPA observed a wooden swings/slide play structure, a wooden play house and tricycles. Also observed a locked shed that is located in the gated side run of the home in where gardening tools, poisons and other hazardous items are stored.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
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: PEREZ, YOANA FAMILY CHILD CARE
FACILITY NUMBER: 103911446
VISIT DATE: 04/29/2021
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  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on January 17, 2019. Applicant will update the Mandated Reporter Training. Applicant understands that the training must be updated every two years.

LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 6:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant 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.



Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
  • Applicant will update her Mandated Reporter Training certification.

Pending verification of correction of the above item and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
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