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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543909774
Report Date: 10/12/2021
Date Signed: 10/12/2021 02:19:18 PM

Document Has Been Signed on 10/12/2021 02:19 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:ALCARAZ, FAVIANA FAMILY CHILD CAREFACILITY NUMBER:
543909774
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee, Faviana AlcarazTIME COMPLETED:
02:45 PM
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On 10/12/21, Licensing Program Analyst (LPA), Jose Penate conducted an unannounced Annual Required Inspection and was met by Licensee, Faviana Alcaraz (Spanish Speaking). Days and hours of operation are Monday – Saturday; 5:00 AM to 9:00 PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, the areas of the home that day care children will have access to are the living room, dining room, and hallway bathroom. LPA gathered updated facility sketch, signed and dated on today’s inspection. All other rooms are off-limits and made inaccessible with safety locks. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition at this home. No poisons were observed during the inspection.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (661) 778-9179.

There is currently no infants in care, LPA discussed infant under the age of 12 months they must sleep in cribs and play yards and will be kept free from all loose articles and objects while infants are sleeping. Infants shall not be swaddled while in care. LPA discussed Individual Infant Sleeping Plan for infants up to 12 months of age. Infants up to 12 months of age will be placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The front yard play area is not fenced and there are no hazards to children present, licensee ensures visual supervision is made while children are at outdoor play. Capacity as specified on the license is being maintained.

Continued on LIC 809-C

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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: ALCARAZ, FAVIANA FAMILY CHILD CARE
FACILITY NUMBER: 543909774
VISIT DATE: 10/12/2021
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Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid is current and will expire 4/28/2022. Mandated Reporter has been completed on 01/30/2021 and will be required to complete every two years from last completion.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



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.

Per Title 22, Division 12, of the California Code of Regulations, no deficiencies were cited.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
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