105620211-7-20-2023-57-CC-NLOI-CTWPS3-20230720113340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 105620211
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:33:53 AM

Document Has Been Signed on 07/20/2023 11:33 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:	GODINEZ, LUZ FAMILY CHILD CARE		FACILITY NUMBER:	105620211
ADMINISTRATOR:	GODINEZ, LUZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 305-9974
CITY:	PARLIER	STATE: CA	ZIP CODE:	93648
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/20/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Luz Godinez		TIME COMPLETED:	11:40 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 7/20/23, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Luz Godinez for a pre-licensing inspection. Applicant, her husband, and three minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on 6/21/23. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: Fire clearance was received on 7/18/23. Licensee states that fire inspector did not require for her to install a fire pull alarm. This is a single story, four bedrooms and two bathrooms home and children will have access to the living room, kitchen/dining room and hallway bathroom. Off-limits rooms are made inaccessible by use of plastic door knob covers. There is heating/cooling ventilation for safety and comfort. LPA observed children size furniture, safe toys, and books for the children. There is a parents board on the right hand side wall of the home's entryway. Children will nap in the living room on cot or mats. Infants will nap in a crib or play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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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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: GODINEZ, LUZ FAMILY CHILD CARE	FACILITY NUMBER: 105620211
	VISIT DATE: 07/20/2023

NARRATIVE

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Applicant’s Pediatric CPR and First Aid certification was completed through American Heart Association and expires on 3/23/25. Applicant's Assistant, Antelmo Sandoval has not completed the training. Applicant understands that her assistant will not be left alone to provide care and supervision to the day care children.
Preventative Health and Safety with Prevention of Lead exposure certification was completed on 3/16/23.
Knives are stored inside a kitchen drawer that is made inaccessible by the use of a magnetic lock. Medications are stored on a top shelf, inside the inaccessible pantry. Other medications are store in inaccessible bedrooms. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof magnetic locks.
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.
There are no bodies of water in the home or premises.
Applicant states there are no pets in the home or on the premises.
Firearms are stored in accordance with Title 22 Regulations and ammunition stored separate in accordance with Title 22 Regulations.
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 states she will 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.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: GODINEZ, LUZ FAMILY CHILD CARE	FACILITY NUMBER: 105620211
	VISIT DATE: 07/20/2023

NARRATIVE

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Fenced backyard has a cemented and sodded area for the children. There are two canopies for shade. There is patio furniture. There is a swings/slide wooden play structure. There are tricycles, balls and other safe toys. There is a storage locked shed where hazardous items are stored.SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on 2/23/23. Applicant’s Assistant completed the training on 3/16/23.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. When any IMS is provided, 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)/ (800) 514-0383.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is 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 states she will operate her day care Monday through Friday from 5:30AM am to 5:30PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: GODINEZ, LUZ FAMILY CHILD CARE	FACILITY NUMBER: 105620211
	VISIT DATE: 07/20/2023

NARRATIVE

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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 anchor to the surface a swings/slide wooden play structure that is located in the backyard.
Applicant will make a utility ladder, several cylinder blocks, panels of wood and dried branches that are located in the backyard.

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.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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