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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909456
Report Date: 09/12/2023
Date Signed: 09/12/2023 04:30:08 PM

Document Has Been Signed on 09/12/2023 04:30 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CARDENAS, SHANNON FAMILY CHILD CAREFACILITY NUMBER:
103909456
ADMINISTRATOR:CARDENAS, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 593-2491
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
09/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Shannon CardenasTIME COMPLETED:
04:30 PM
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On September 12, 2023, Licensing Program Analyst (LPA), Migue Herrera conducted an unannounced Annual Required Inspection and was met by Licensee Shannon Cardenas. During the inspection there was an assistant present at all times. Days and hours of operation are Monday through Friday, 6:30AM through 4:30PM. The home has working telephone service and LPA confirmed the phone number is 559-593-2491.

LPA toured the home inside and outside and a census was taken. LPA Herrera conducted a census and there are 10 children in the home with Licensee, 2 of the children at the home are infants. Capacity as specified on the license is being maintained. 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. LPA reviewed current facility sketch and confirmed that the living room, family room, bathroom, kitchen, dinning room, and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by door knob spinners. Facility has stairs and a second floor, which is off limits to daycare children and are made inaccessible by a safety gate. The fireplace located in the family room is secured with a screen inaccessible to daycare children.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a working fire extinguisher located in the kitchen. The smoke detector and carbon monoxide detector are in working conditions and are located in the family room. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. There is adequate heating and ventilation for safety and comfort of the children. LPA was able to observe fire drill documentation with the date, time and how many children present, at least every six months. Licensee has a current roster of the children.

During the inspection, LPA observed safe toys and play equipment in the living room. LPA did not observe any hazardous items in the kitchen. The bathroom used by children was observed to be free from hazards.

To be continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CARDENAS, SHANNON FAMILY CHILD CARE
FACILITY NUMBER: 103909456
VISIT DATE: 09/12/2023
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LPA observed three dogs and two cats in the home. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets. The outdoor play area in the backyard is fenced. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. LPA Herrera advised Licensee to regularly maintain the fence as weather, and normal wear and tear can degrade the mesh fence. Licensee is aware of child safety around the pool and assumes all responsibility. Licensee ensures that children in care are always supervised.

LPA reviewed a sample of children’s files and observed files were complete with the immunizations and required documentation. Licensee’s Mandated Reporter Training expires on 06/07/2025. Licensee’s pediatric CPR/First Aid certification expires on 4/11/2025. A review of records indicates that licensee has immunization records on file for influenza, pertussis, and measles. Currently Licensee has an Assistant. Licensee was able to produce Assistant’s complete immunization records with Tuberculosis clearance. Assistant’s Mandated Reporter Training expired on 06/27/2023. Assistant's pediatric CPR/First Aid certification expires on 04/11/2025.


LPA observed two infants in care during the inspection. LPA observed two cots for the infants in care, it is kept free from all loose articles and objects while infants were sleeping, and there are no objects hanging above or attached to the cot. Licensee stated that infants are not swaddled while in care. Licensee also stated the two infants can physically climb out of the play yard as they are mobile therefore, she places them in a cot for safety precautions. Licensee checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed as they sleep in the family room. Individual 15 minute sleeping logs are completed and in file for each infant up to 24 months of age. Per licensee Infants up to 12 months of age are placed on their backs for sleeping.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. To be continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CARDENAS, SHANNON FAMILY CHILD CARE
FACILITY NUMBER: 103909456
VISIT DATE: 09/12/2023
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LPA discussed safe sleep regulations with Licensee 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 Licensee 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 facility does not provide Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Licensee Shannon Cardenas. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are no deficiencies.

Licensee Shannon Cardenas was provided appeal rights.

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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC809 (FAS) - (06/04)
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