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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911581
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:08:13 PM

Document Has Been Signed on 02/09/2022 12:08 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:DIAZ, ANA FAMILY CHILD CAREFACILITY NUMBER:
543911581
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
02/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ana DiazTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Diane Mercado made a Case Management inspection. LPA met with Licensee Ana Diaz (Spanish Speaking) and toured facility inside and outside, census taken. Purpose of today's inspection was to conduct a 90-day follow-up on initial Pre-licensing visit which took place on 09/16/2021. Reviewed a sample of children files, required forms were in the files. This is a single story home that day care children will have access to are the living room, dining room, and hall bathroom. Off-limits rooms and closets are made inaccessible children safety plastic door knobs, and child safety gate. Hours of operation are 8:00 A.M to 6:00 P.M Monday through Friday.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies observed during today’s inspection. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Ana..

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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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