103912691-6-2-2025-04-CC-PZAO-DH9UR8-20250602154821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103912691
Report Date: 06/02/2025
Date Signed: 06/02/2025 03:48:39 PM

Document Has Been Signed on 06/02/2025 03:48 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:	PEREZ, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	103912691
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	06/02/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Sandra Perez		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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 June 2, 2025, Licensing Program Analyst (LPA), Priscilla Zamudio met with Applicant/Licensee, Sandra Perez for a change of location inspection. Applicant is the only resident in the home. Background clearances are discussed and LIS 531/Roster Report were signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Applicant also applied for large license and a fire clearance was granted on 5/29/25. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: · Fire clearance was received on 6/2/2025. Applicant states that fire inspector did not require for her to install a fire pull alarm. · On this date, 4/17/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. · This is a single story 3 bedroom, 1 bathroom home and children will have access to the living room, dining room, kitchen, bedroom 2, bedroom 3 and bathroom. Off-limits rooms are made inaccessible by use of door knob spinners. (CONTINUED ON 809-C)

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Priscilla Zamudio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: PEREZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103912691
	VISIT DATE: 06/02/2025

NARRATIVE

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·Applicant’s Pediatric CPR and First Aid certification was completed through American Safety & Health Institute Emergency Medical Services Authority stickers (EMSA) and expires on 12/14/2026.
· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on 6/7/19. Certificate of Lead Poisoning Prevention was completed on 8/5/2021.
· Applicant completed the Mandated Reporter Training on 5/22/2024. The required training can be found at www.ccld.ca.gov.
· SB 792 immunizations verified and on file.
· Applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).
· Applicant stated she is in the process of moving items for daycare such as toys, books and games for the children. LPA observed a small play kitchen and advised to wipe down items. Applicant stated the children will nap in the bedrooms using mats. Applicant understands she is to supervise children at all times.
· Fenced backyard has grass and cemented area for the children. There is an anchored swingset with shade above.
· Facility has 3A40BC fire extinguisher, smoke alarm, and carbon monoxide alarm. Applicant stated she has not moved her first aid kit supplies from the other home.
· LPA did not observe any items stored in the kitchen cabinets. Applicant stated the knives and medications will be stored in kitchen cabinets with safety latches. LPA observed other safety latches throughout cabinets. Cleaning compounds are stored in the laundry room that will be off limits with a safety door knob spinner.
· There are no bodies of water in the home or premises.
· Applicant states there will be one dog kept outside in a kennel during day care hours. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
· Applicant states there are no firearms or ammunition in the home or premises.
· Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
· Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
(CONTINUED ON 809-C)

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Priscilla Zamudio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

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: PEREZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103912691
	VISIT DATE: 06/02/2025

NARRATIVE

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·Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
· Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
· Applicant is advised Fresno Community Care Licensing Department has inspection authority and can inspect all rooms in the home, garages and/or separate dwellings on the premises.
· Applicant states she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information and-resources/safe-sleep, as an additional resource. LPA also informed applicant, 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. LPA provided applicant with Individual Infant Sleeping Plan and Safe Sleep handout.
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
(CONTINUED ON 809-C)

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Priscilla Zamudio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

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: PEREZ, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103912691
	VISIT DATE: 06/02/2025

NARRATIVE

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Applicant was advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant, was informed of the MyChildCarePlan.org site, a consumer education
website that helps families obtain child care by connecting them to child care providers and
Resource and Referral Agencies (R&Rs) throughout California. Applicant states she will operate her day care Monday through Friday from 5:00 am to 5:00 pm and as arranged. No overnight care will be provided.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities,
providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly
Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.

· Applicant will ensure carpets and floors are clean and in good repair, wipe down children’s items in the bedrooms with paint dust and install a safety gate in off limits den area. Applicant will also show verification of first aid kit.

Pending verification of corrections of the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.

Exit interview conducted and report was reviewed with the applicant.

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Priscilla Zamudio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

LIC809 (FAS) - (06/04)

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