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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911128
Report Date: 08/06/2021
Date Signed: 08/06/2021 02:47:03 PM

Document Has Been Signed on 08/06/2021 02:47 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:BARRERA, SONIA FAMILY CHILD CAREFACILITY NUMBER:
103911128
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
08/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Tita Pena- Licensee's AssistantTIME COMPLETED:
03:00 PM
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LPA Lomeli arrived to the family child care home to conduct a Case Management- Licensee Initiated inspection for a capacity increase. Licensee's Assistant, Tita Pena answered the door and informed LPA that Licensee, Sonia Barrera had left to a doctor's appointment. Ms. Pena welcomed LPA in. LPA observed six day care children awake in the living room and one preschool child asleep in the day carer room. Ms. Pena stated that she is qualified to be an assistant but has recently started helping licensee and does not know where she stores her certifications. LPA verified with the LIS531 that Ms. Pena is associated to the facility and has a fingerprint clearance. LPA informed Ms. Pena that in order for LPA to grant the capacity increase LPA will need to have the required documentation for licensee and licensee's assistant; current Pediatric CPR/First Aid certifications, current Mandated Reporter Training certifications, Measles, Pertussis and Influenza vaccinations. LPA informed Ms. Pena that she will return for a second inspection when the licensee is home.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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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