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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153807513
Report Date: 07/18/2023
Date Signed: 07/18/2023 02:16:18 PM

Document Has Been Signed on 07/18/2023 02:16 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:JUAREZ, IMELDA FAMILY CHILD CAREFACILITY NUMBER:
153807513
ADMINISTRATOR:JUAREZ, IMELDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 792-3506
CITY:MCFARLANDSTATE: CAZIP CODE:
93250
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee, Imelda JuarezTIME COMPLETED:
02:30 PM
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On 07/18/2023, Licensing Program Analyst's (LPAs), Jose Penate and Valerie Mireles, conducted an unannounced Annual Required Inspection and was met by Licensee, Imelda Juarez and assistant (Spanish speaking). Days and hours of operation are Monday through Saturday from 4:00 a.m. to 4:30 p.m.

LPA toured the home inside and outside and a census was taken. 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. Current facility sketch was reviewed, and Licensee confirmed that the living room, dining room, kitchen, garage daycare room, hallway restroom, and back yard are used for providing care and are accessible to children. Facility is a one-story home. There is a fireplace in the home that is inaccessible by a glass cover and is not used during daycare hours. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. During inspection LPA’s observed in laundry room that was accessible to children have cleaning products (Tide, Clorrox, cleaning wipes, sanitizer, etc) and in hallway bathroom hygiene products, medication and ointment were accessible to children in care.



There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. The home has working telephone service and LPA confirmed the phone number is 661-792-3506.

LPA and licensee discussed Safe Sleep Regulations. Licensee is aware that cribs and play yards are to be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard.

Provider is aware to physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Individual Infant Sleeping Plan is to be completed for each infant up to 12 months of age upon enrollment. LPA discussed with licensee, Infants up to 12 months of age shall be placed on their backs for sleeping.

(Continued on 809-C)
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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: JUAREZ, IMELDA FAMILY CHILD CARE
FACILITY NUMBER: 153807513
VISIT DATE: 07/18/2023
NARRATIVE
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required; however, one infant file was missing LIC9227 form. Licensees Mandated Reporter Training was completed on 08/26/2021. Licensee’s pediatric CPR/First Aid expires on 02/26/2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are currently not being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies being cited (See LIC809-D).

Exit interview conducted and report was reviewed with Licensee, Imelda Juarez.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/18/2023 02:16 PM - It Cannot Be Edited


Created By: Jose Penate On 07/18/2023 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JUAREZ, IMELDA FAMILY CHILD CARE
FACILITY NUMBER: 153807513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During inspection LPAs observed cleaning supplies and products. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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All items were removed by licensee and made inaccessible to children in care. (Deficiency cleared on 07/18/2023 during inspection).
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. File for infant under the age of 12 months was missing LIC9227 Form. This poses a potential health, safety or personal rights risk to infant in care.
POC Due Date: 07/21/2023
Plan of Correction
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Licensee will provide a scanned copy to LPA by 07/21/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2023


LIC809 (FAS) - (06/04)
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