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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910428
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:23:48 AM

Document Has Been Signed on 11/21/2023 11:23 AM - 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:GONZALEZ, LAURA FAMILY CHILD CAREFACILITY NUMBER:
103910428
ADMINISTRATOR:GONZALEZ, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 392-4882
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Laura GonzalezTIME COMPLETED:
11:35 AM
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On 11/21/2023 Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced case management – unusual incident inspection. LPA Mendoza met with Licensee Laura Gonzalez, toured the facility, and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 10/31/2023. The incident reported was regarding an unusual incident that took place on 10/31/2023 where it was reported that child #1 was getting into a child’s chair where child #1 miscalculated sitting and fell bumping their mouth on the floor by the kitchen area of the facility that resulted in child #1 having two small cuts on their upper gums.

During today's inspection, LPA Mendoza interviewed staff regarding the unusual incident, inspected facility, and reviewed records.

The unannounced case management – unusual incident inspection yielded evidence that the facility followed reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident is an isolated event and not a result of lack of care and supervision. Based on LPA observations, staff interviews, and records reviews there are clear indications that the facility provided first aide to child #1 and contacted the child’s parents immediately to inform them of the event and child #1 returned to care to the facility the next day on 11/01/2023.

No deficiencies cited in the areas observed today.

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

LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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