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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163911454
Report Date: 10/13/2021
Date Signed: 10/13/2021 01:13:34 PM

Document Has Been Signed on 10/13/2021 01:13 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:COOPER, MICHAELA FAMILY CHILD CAREFACILITY NUMBER:
163911454
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
10/13/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Michaela CooperTIME COMPLETED:
01:35 PM
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On 10/13/2021, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection as a post licensing inspection. LPA met with Licensee, Michaela Cooper, who provided a tour of the home, inside and outside, as shown on the facility sketch. There were no bodies of water. Firearms and ammunition were properly stored. Poisons, cleaning compounds, medications and other hazardous items were inaccessible to children. The fireplace was located in the family room and was made inaccessible to children by a glass door. The fire extinguishers, smoke detectors, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. Stairs are barricaded when children under age 5 years old are present. Safe toys and play equipment were observed. There was a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Outdoor play areas were fenced or supervised by the Licensee or caregiver. Capacity as specified on the license was being maintained. Children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. A review of records indicated Licensee and all employees and/or volunteers have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot. Records also indicated Licensee was current on Mandated Reporter Training. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee's pediatric CPR and First Aid expires on 3/7/2022.

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 (continued on next page)
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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: COOPER, MICHAELA FAMILY CHILD CARE
FACILITY NUMBER: 163911454
VISIT DATE: 10/13/2021
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LPA and Licensee discussed Reporting Requirements and completing an Unusual Incident Report (LIC 624B) for all unusual incidents that occur at the facility.

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.

Business hours are Monday through Friday 7:00 AM to 5:30 PM and other hours as arranged.

Per California Code of Regulations, Division 12, Title 22, no deficiencies were observed today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Michaela Cooper.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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