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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911451
Report Date: 05/12/2021
Date Signed: 05/12/2021 12:25:48 PM

Document Has Been Signed on 05/12/2021 12:25 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:IBARRA, ROSALINDA FAMILY CHILD CAREFACILITY NUMBER:
103911451
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/12/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosalinda IbarraTIME COMPLETED:
12:45 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 May 12, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Rosalinda Ibarra for a pre-licensing inspection. Applicant, her husband, her adult son and one minor child resides 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, three bedrooms and two bathrooms home and children will have access to the living room, dining room (day care room), bedroom #3 and hallway bathroom. Off-limits rooms are made inaccessible by use of key locks and child proof safety gates.
  • There is a fireplace in the living room that applicant states it will not be used during day-care hours.
  • LPA observed in the day care room children size furniture, safe toys and books for the children. There is a parents board on the left hand side of the wall of the home's entry way. Children will nap in living room and day care room on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times.
  • Facility has 2A10BC 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 January 19, 2023.
  • Preventative Health and Safety class was completed on December 8, 2020.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2021
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: IBARRA, ROSALINDA FAMILY CHILD CARE
FACILITY NUMBER: 103911451
VISIT DATE: 05/12/2021
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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 5:00 AM to 10:00 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.



Licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective May 13, 2021.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
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: IBARRA, ROSALINDA FAMILY CHILD CARE
FACILITY NUMBER: 103911451
VISIT DATE: 05/12/2021
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  • Knives are stored in a top kitchen cabinet inside a plastic container. Medications are stored inside a top kitchen cabinet. The kitchen, laundry room and door that leads to the garage are made inaccessible by the use of a child proof safety gate. Cleaning compounds are stored in the garage inside a locked storage cabinet.
  • 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.
  • Applicant states there are no pets in the home or on the premises.
  • Applicant states there are no firearms, ammunition or poisons in the home or premises.
  • 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 that she will 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 has a cemented area for the day care children to play. There is patio furniture and a porch for shade.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training certification on December 18, 2020.
  • 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.

(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
LIC809 (FAS) - (06/04)
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