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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 105620211
Report Date: 09/14/2023
Date Signed: 09/14/2023 08:48:38 AM

Document Has Been Signed on 09/14/2023 08:48 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GODINEZ, LUZ FAMILY CHILD CAREFACILITY NUMBER:
105620211
ADMINISTRATOR:GODINEZ, LUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 305-9974
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Luz GodinezTIME COMPLETED:
09:00 AM
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On 09/14/2023, Licensing Program Analyst (LPA) Gloria Reyes conducted a case management inspection. LPA met with Licensee, Luz Godinez. The purpose of today's visit is to conduct a 90 Day follow-up on initial prelicensing visit and no children were present. Background clearances were reviewed and verified. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight. A tour of the home, inside and outside, as shown on the facility sketch was done. The children will have access to the living room, kitchen/dining room and hall bathroom.

Required forms are posted. Children's files were not reviewed today as licensee has not cared for children since licensure. Licensee understands once children are in care she is to have all required forms in file prior to children attending the daycare. Licensee understands she is to conduct fire and disaster drills at least once every six months and document the date and time of each drill. Fire extinguisher, smoke detector, carbon monoxide detector and first aid kit are operable and in place. Firearms are stored in accordance with Title 22 Regulations and ammunition stored separate in accordance with Title 22 Regulations. There are no "bodies of water" in this home. An anchored play structure and locked shed was observed in backyard.

Health and Safety training, Pediatric CPR, and Pediatric First Aid training are current and expire on 03/23/25. LPA verified that the required immunizations and the required Mandated Child Abuse Reporter (AB 1207) training was completed on 02/23/23.

LPA reviewed Safe Sleep guidelines with licensee. Days/Hours of Operation: Monday through Friday, 5:30 AM to 5:30 PM.



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: Duane Matsubara
LICENSING EVALUATOR NAME: Gloria Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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