<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911452
Report Date: 01/05/2024
Date Signed: 01/05/2024 09:25:28 AM

Document Has Been Signed on 01/05/2024 09:25 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:CRUZ DE SEGOVIA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
103911452
ADMINISTRATOR:CRUZ DE SEGOVIA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 755-1757
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria Cruz De SegoviaTIME COMPLETED:
09:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/05/24, Licensing Program Analyst (LPA) Martha De Haro conducted an unannounced case management inspection. LPA toured the facility, and a census was taken. LPA met with licensee Maria Cruz De Segovia. The conversation with licensee was held in Spanish. The purpose of today's inspection was to go over regulations regarding smoking in the facility and reporting requirements.

During the case management inspection, LPA spoke at length with the licensee and ensured that licensee understood that smoking or vaping is not allowed in a licensed childcare home as she had previously disclosed that her adult daughter uses electronic cigarettes. Licensee agreed to enforce this rule. LPA also discussed reporting requirements with licensee and went over how to complete the Unusual Incident Report, LIC 624B (SP). LPA gave a copy of this form to the licensee. LPA also observed a small hole in the dining room closet door that was previously broken by licensee’s adult daughter. Licensee indicated that she was in the process of repairing the hole in the door. LPA discussed with licensee that the home needs to be kept clean and in good repair at all times for the children’s safety.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee Maria Cruz De Segovia and a copy of the report and appeal rights were given and discussed.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Martha DeHaro
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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 1