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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 105620023
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:29:22 AM

Document Has Been Signed on 03/15/2023 11:29 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GONZALEZ, ELIAZAR FAMILY CHILD CAREFACILITY NUMBER:
105620023
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
03/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Eliazar GonzalezTIME COMPLETED:
11:45 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 03/15/2023, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced case management inspection to inspect a bedroom the Licensee would like to add to her license. LPA explained purpose of inspection, toured facility and took a census.

LPA inspected Bedroom #1 and observed a bed, small dresser, and night stand. LPA did not observe any hazards present. Licensee stated she would like to use the bedroom for sleeping infants only. Licensee stated she understands she will be required to keep the bedroom door open to be able to observe and hear sleeping infants. Licensee confirmed she understands safe sleep regulations and showed LPA the documentation she keeps of checking infants every 15 minutes while sleeping as required. Licensee stated she will only put sleeping infants in playpen or crib for sleep with nothing in the playpen other than infant on top of fitted sheet.

As of 03/15/2023, Bedroom #1 is added to the license. Facility sketch has been updated.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency cited.

Exit interview conducted with licensee. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Candis Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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