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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911617
Report Date: 11/01/2021
Date Signed: 11/01/2021 12:51:21 PM

Document Has Been Signed on 11/01/2021 12:51 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:RODRIGUEZ, GLADYS FAMILY CHILD CAREFACILITY NUMBER:
543911617
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Gladys RodriguezTIME COMPLETED:
01:00 PM
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On 11/01/2021 a planned Pre-licensing inspection was made today by Licensing Program Analyst (LPA) Rene Mancinas, who met with Applicant, Gladys Rodriguez. A tour of the home, inside and outside, as shown on the facility sketch was done. This is a single-story home. The areas of the home that day-care children will have access to are the living room, dining room, kitchen, and children’s restroom. The remainder of the home is off limits and made inaccessible by means of child safety devices. Applicant, husband, and two other adults are the only adults that resides in the home. The LIS 536 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 play areas, child safety plugs in unused electrical outlets, child safety latches on cabinets and/or cabinets with safe items, were all observed. Fire extinguisher, smoke detectors, carbon monoxide detectors and first aid kit are operable and in place. There are no firearms or ammunition present at this home. There is no in-ground swimming pool or other bodies of water at this home. CPR, first aid training, and health and safety training are current and expiring 12/12/2022. Child Abuse Mandated Reporter Training Completed on 01/31/2021. Postings, forms, and licensing information 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. There are pets at this home. Applicant understands responsibility of any action taken by pets involving day care children.

Incidental Medical Services (IMS) policy were 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 809-C)

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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: RODRIGUEZ, GLADYS FAMILY CHILD CARE
FACILITY NUMBER: 543911617
VISIT DATE: 11/01/2021
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Applicant 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, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to eight children. Pending 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 effective 11/02/2021. Planned hours of operation are Monday through Friday from 04:30AM - 05:30PM, and as arranged.

Exit interview conducted and report was reviewed with the applicant.
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: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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