203911546-8-4-2021-04-CC-NLOI-C5KQH3-20210804121027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203911546
Report Date: 08/04/2021
Date Signed: 08/04/2021 12:10:39 PM

Document Has Been Signed on 08/04/2021 12:10 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:	TATE, SHERI FAMILY CHILD CARE		FACILITY NUMBER:	203911546
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/04/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sheri Tate		TIME COMPLETED:	12:30 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	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On August 4, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Sheri Tate for a pre-licensing inspection. Applicant and her husband 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, three bedrooms and three bathrooms home and children will have access to the living room, kitchen, formal dining room, dining room, family room (day care room) 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. Children will nap in 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 March 20, 2023. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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: TATE, SHERI FAMILY CHILD CARE	FACILITY NUMBER: 203911546
	VISIT DATE: 08/04/2021

NARRATIVE

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Preventative Health and Safety class was completed on March 19, 2021.
Knives are stored in their knife block inside the kitchen pantry that is kept key locked. Medications are stored in the inaccessible master bathroom. Cleaning compounds are stored inside a hallway closet that is kept key locked.
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 is a Pot-Bellied pig and two goats that are kept in the backyard inside their individual pen. There are two dogs that will be inaccessible to the day care children. There are two horses in a corral that is located in front of the home. LPA also observe a chicken coop with chickens and rooster. The chicken coop is located on the side of the front of the home. 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 states that there are no poisons in the home.
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 has a designated area for the day care children. LPA observed a canopy for shade, a wooden play house, two Little Tikes Peddle and Go carts, balls, a toddler slide and a basketball hoop for the day care children.
SB 792 immunizations verified and on file.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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: TATE, SHERI FAMILY CHILD CARE	FACILITY NUMBER: 203911546
	VISIT DATE: 08/04/2021

NARRATIVE

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Applicant completed the Mandated Reporter Training on March 30, 2021.
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 6:00 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.

Licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective August 9, 2021.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC809 (FAS) - (06/04)

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