<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910934
Report Date: 04/16/2021
Date Signed: 04/16/2021 11:35:55 AM

Document Has Been Signed on 04/16/2021 11:35 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:DIAZ, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
153910934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elizabeth DiazTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 04/16/2021 A planned Prelicensing inspection was made today by Licensing Program Analysts (LPAs) Daniel Alvarez and Roman Iglesias, who met with Applicant Elizabeth Diaz. There are two fireplaces in the home that will not be used during day-care hours. A tour of the home, inside and outside, as shown on the facility sketch was done. The areas of the home that day care children will have access to are the living room, dining room, kitchen, and master bedroom and bathroom. Background clearances were reviewed and verified. Only the applicant lives in the home. The LIS 531 was signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. LPA observed safe toys, safe indoor and outdoor play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items, and a clean and orderly home were all observed. Fire extinguisher, smoke detectors, carbon monoxide detector, and first aid kit are operable and in place. Off-limits rooms are made inaccessible by child safety plastic door knobs and locked doors. Applicant stated there are no firearms or bodies of water at this home, nor did LPA observed these items. Postings, forms, and immunization cards were provided and discussed. LPA discussed the practice of fire and disaster drills at least every 6 months and to document the date, time and number of children present. Applicant does not have any pets. Fact Sheet for Assembly Bill 633 - Child Care Parent Notification Requirements was discussed and copies were provided to applicant - (Fact Sheet and LIC 9224 -Acknowledgement of Receipt of Licensing Reports), The current LIC 995A (12/06) Notification of Parent's Rights and Pub 394 (12/06) -Notification of Parents Rights poster were also provided.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2021
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 2
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: DIAZ, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 153910934
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Before Licensure the following items are to be corrected to avoid the application form being withdrawn:

1. Applicant needs to renew her CPR and first aid training, her card expired on 11/24/2021.

Pending verification of corrections and a final review of your application, licensure as a Small Family Child Care Home capacity of eight children* ages under 18 years, will be recommended. Planned hours of operation are Monday through Saturday from 5:00AM - 7:00PM and as arranged.

A copy of this report is to remain in the facility for public review.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2