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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 105620001
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:34:28 PM

Document Has Been Signed on 01/10/2024 03:34 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:PEREZ, MARISOL FAMILY CHILD CAREFACILITY NUMBER:
105620001
ADMINISTRATOR:PEREZ, MARISOLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 907-3160
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
01/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Marisol PerezTIME COMPLETED:
03:40 PM
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On this date, Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced case management inspection at the facility. LPA met with Licensee Marisol Perez to discuss a Confirmation of Removal form that was mailed to the Licensee's mailing address from Department of Social Services, Caregiver Background Check Bureau, on 12/11/2023. LPA toured facility inside and outside and took a census. Licensee's assistant was present.

On 01/08/2024, Ms. Perez notified Community Care Licensing that she had received the Confirmation of Removal form and had submitted it to licensing via mail. Ms. Perez provided a copy of the signed Confirmation of Removal form to LPA. Ms. Perez indicated the individual named on the form has not been present at the facility since 04/11/2020. LPA informed Ms. Perez that the Department has denied the criminal record exemption for this individual. Based on evidence obtained during today’s visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA has advised Ms. Perez to disassociate the individual from the Guardian personnel report and LPA was provided with an updated Personnel Summary (LIC 500). Verification of removal is complete.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies cited.

An exit interview conducted with Licensee Marisol Perez. LPA provided Licensee a copy of LIC 995B – Family Child Care Home Addendum to Notification of Parents Rights, which must be signed by each current daycare child’s parent and a copy retained in the child’s file. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.

SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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