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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911176
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:54:20 PM

Document Has Been Signed on 01/19/2023 03:54 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GALLEGOS, EDITH FAMILY CHILD CAREFACILITY NUMBER:
103911176
ADMINISTRATOR:GALLEGOS, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 356-7927
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Edith GallegosTIME COMPLETED:
04:10 PM
NARRATIVE
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On 1/19/2023 Licensing Program Analysts (LPAs) Ruby Ocegueda and Denisia Jimenez, conducted an unannounced Annual Required Inspection and was met by Licensee, Edith Gallegos. Also present was Staff #2 (S2) and Staff #3 (S3). Days and hours of operation are Monday through Friday from 5:00 AM to 5:00 PM or other hours as arranged.

LPAs toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the bathroom, dining room and the playroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of baby gates and door knob safety covers. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication are made inaccessible.

The fireplace located in the playroom and dining room are made inaccessible by a furniture and metal door and will not be in use during daycare hours. There is one fireplace in the second floor that is made inaccessible by a baby gate. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are fenced or barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 356-7927.

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care.

Report continued 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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Document Has Been Signed on 01/19/2023 03:54 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 01/19/2023 at 02:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GALLEGOS, EDITH FAMILY CHILD CARE
FACILITY NUMBER: 103911176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review the licensee did not comply with the section cited above. Upon arrival, LPA's Ocegueda and Jimenez observed staff #3 providing care and supervision of 6 children while licensee was upstairs. Interviews revealed that staff #3 moved in the home some time between November 2022 and January 1st 2023 (exact unknown). It was determined that staff #3 did not have a criminal record clearance or exemption as required before moving in the home or providing care and supervision. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2023
Plan of Correction
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Licensee sent staff #3 to get fingerprinted. Licensee stated that staff #3 would reside with outside family immediately until she obtained proper criminal record clearance from the Department and will not provide care and supervision to children or be present while day care children are in care. Licensee understands that the deficiency will be cleared when staff #3 is granted a criminal record clearance or exemption. Proof of completed Livescan form will be submitted to the Department by POC date: 1/20/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susie Fanning
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/19/2023 03:54 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 01/19/2023 at 02:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GALLEGOS, EDITH FAMILY CHILD CARE
FACILITY NUMBER: 103911176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above. In the back yard, the licensee had an electric saw, a lawn mower and a propane tank that was connected to the BBQ pit. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2023
Plan of Correction
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Today, staff #2 removed the lawn mower and saw to an inaccessible area of the yard. Staff #2 also disconnected the propane tank from the BBQ pit. In the play yard, there was a large canopy that was toppled over which caused it to cover the play equipment. The play yard will be deemed off limits (facility sketch was updated today). Upon the repair, removal or replacement of the broken canopy, the licensee will contact the Department to reinspect the yard for approval. Deficiency cleared today.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susie Fanning
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


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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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GALLEGOS, EDITH FAMILY CHILD CARE
FACILITY NUMBER: 103911176
VISIT DATE: 01/19/2023
NARRATIVE
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Provider physically checks on sleeping infants every fifteen minutes and the requirement to document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing was discussed. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan was discussed and a copy was provided to licensee. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and was inspected. LPA observed that there was a lawn mower, an electric saw that was unplugged on top of a shelf and a connected propane tank. The door leading to the back yard was locked from the top where the children could not reach, however on the facility sketch, the back yard was deemed as accessible.

Today, staff #2 removed the lawn mower and saw to an inaccessible area of the yard. Staff #2 also disconnected the propane tank from the BBQ pit. In the play yard, there was a large canopy that was toppled over which caused it to cover the play equipment. The play yard will be deemed off limits (facility sketch was updated today). Upon the repair, removal or replacement of the broken canopy, the licensee will contact the Department to reinspect the yard for approval. Deficiency cleared today.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 1/11/2023. Licensee’s pediatric CPR/First Aid expires on 1/9/2025. A review of records indicates that 2 out of 3 staff and/or volunteers have immunization records on file for influenza, pertussis and measles.

Upon arrival, LPA’s Ocegueda and Jimenez met with observed staff #3 who was caring for children while licensee and staff #2 were upstairs. Upon record review, it was determined that staff #3 did not have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm. Report continued to 809-C


SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GALLEGOS, EDITH FAMILY CHILD CARE
FACILITY NUMBER: 103911176
VISIT DATE: 01/19/2023
NARRATIVE
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

An exit interview was conducted with licensee Edith Gallegos. 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: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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