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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909735
Report Date: 06/10/2025
Date Signed: 06/10/2025 05:46:59 PM

Document Has Been Signed on 06/10/2025 05:46 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PENA, ROBBIN FAMILY CHILD CAREFACILITY NUMBER:
153909735
ADMINISTRATOR/
DIRECTOR:		PENA, ROBBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 746-2841
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
06/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Robbin PenaTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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On 06/10/2025 Licensing Program Analyst (LPA), Christopher Burnias conducted an unannounced Annual Random Inspection and was met by licensee Robbin Pena. Days and hours of operation are Monday through Friday from 6:30 AM to 5:00 PM.

LPA toured the home inside and outside and a census was taken. LPA reviewed current facility sketch and confirmed that the kitchen, dining room, restroom, play room, big living room, and mini living room are used for providing care and are accessible to children. All other rooms are off-limits.

LPA observed off limits closets to have missing doorknob spinners. Licensee is to ensure all off limits areas of the home are made inaccessible by doorknob spinners, gates, or locks.

Upon inspection of the play room, LPA observed carpet with debris, and food particles, closet doors dirty and stained, and excess toys cluttered throughout the room. LPA advised Licensee to have the room cleaned and to remove excess items not currently being used.

Upon inspection of the living room, LPA observed furniture drawers and cabinets to have various stains. LPA advised Licensee to keep all accessible areas of the home, and furniture clean.

Upon inspection of the kitchen, LPA observed various tools, batteries, nail polish, and a lighter inside unlocked kitchen drawers. Licensee was advised to remove the hazardous items or to install drawer locks to prevent children from accessing the contents of the drawers.

There is one fireplace in the home located in the big living room and is made inaccessible by a glass door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:04 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. LPA observed floors to have dirt, debris, and food particles, walls, doors, cabinets, and drawers with various stains and excess clutter in accessible areas of the home which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to have all accessible areas of the home cleaned and decluttered.
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. LPA observed spiderwebs, dog feces, loose, damaged and broken fence panels, peeling paint on patio table, peeling seat cushions on patio chairs, and collected water pooled in the backyard which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to remove spider webs and dog feces. Licensee is to ensure the fence is secured and repaired. Licensee is to repair or remove the patio table and chairs. Licensee is to ensure that excess water from outdoor sprinklers is drained.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:04 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

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 LPA observation, the licensee did not comply with the section cited above. LPA observed a gas tank, lawn mower, knife, and fence panels with exposed nails in the backyard. LPA also observed tools, nail polish, batteries, and a lighter inside drawers in the kitchen. LPA observed off limits closets accessible to children. These conditions pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to remove the gas tank, lawn mower, knife, tools, nail polish, batteries, lighter, and any other potentially hazardous items from the home or move them to an inaccessible area of the home. Licensee is to ensure fence is secured and repaired. Licensee is to ensure all off limits areas of the home are made inaccessible by door locks, gates, or doorknob spinners.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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. Licensee and assistant did not have proof of valid Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee and assistant are to complete Mandated Reporter Training and to submit completion certificate to the Department.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:04 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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. LPA observed that Licensee did not have documentation of immunizations for themself or for their assistant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to create folder for themself and for assistant which contains immunization documents for Measles, Pertussis, Influenza, and TB clearance. Licensee is to provide documents to the Department.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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. Licensee did not have a valid Pediatric First Aid/CPR training certificate issued by an approved training program which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to complete Pediatric First Aid/CPR training through an approved program through American Heart Association, American Red Cross, or authorized California Emergency Medical Services Authority (EMSA) trainer. Licensee is to submit completion certificate to the Department.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:04 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.2(a)(2)
Reporting Requirements
(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

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. Departmental records show that Licensee did not report that their adult child moved into the home which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to review regulations and provide a statement to the Department that they have read and understood the regulation and will ensure compliance with licensing requirements.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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. LPA observed that children's records were missing immunization documents for Measles and Pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to obtain immunization documents for Measles and Pertussis from parents. Licensee is to provide the Department a copy of the immunization documents and to keep documents in children's files.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:04 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

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. LPA observed children's emergency documents to be incomplete and missing signatures. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee is to ensure all emergency documents are completed and signed. Licensee is to submit documents to the Department as proof of completion and keep documents in children's files.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 06/10/2025 05:46 PM - It Cannot Be Edited


Created By: Christopher Burnias On 06/10/2025 at 03:17 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: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility......(1) Obtain a California clearance or a criminal record exemption as required by the Department...

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. Licensee's adult child has been residing in the home without a criminal record clearance assigned to the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2025
Plan of Correction
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Licensee is to have their adult child fingerprinted and have a criminal record clearance associated to the facility. Licensee is to submit proof to the Department that the adult child submitted fingerprints, and Licensee is to provide the Department proof of approved eligible criminal background clearance for the adult child.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Luisa Gavoutian
NAME OF LICENSING PROGRAM MANAGER:
Christopher Burnias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 06/10/2025
NARRATIVE
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This is a single level home and there are no stairs.

The home has working telephone service and Licensee proved LPA with an updated telephone number.

There are no firearms or ammunition on the premises.

Upon inspection of the backyard, LPA observed a tank of gasoline, a lawn mower, and a knife. Children were not outside, however LPA explained that the items observed are hazardous to children. Licensee agreed to have items moved to an inaccessible area of the home.

In the grass area of the backyard, LPA observed a large trampoline. Licensee informed LPA that day care children use the trampoline a few at a time. LPA informed Licensee that children using the trampoline can increase the risk of injury. LPA advised Licensee that if they plan to have children use the trampoline to have them use it one at a time and ensure that children do not crawl underneath the trampoline. LPA also informed Licensee of the risk of trampoline parts pinching or injuring a child. Licensee understands they are to ensure supervision of children around the trampoline.

LPA also observed dog feces on the grass area of the backyard. LPA advised Licensee to regularly check backyard for pet messes and to ensure that the outdoor area is cleaned before children have access to it.

LPA observed water collecting in the rear part of the backyard where plants are. LPA explained how water that collects and pools up can be an area where mosquitos can breed and how the collected water can pose a drowning hazard to children in care. Licensee stated they will monitor their sprinklers to ensure that the area does not get flooded with excess water.

There is no swimming pool or other large bodies of water on the premises.

LPA observed paint on a patio table to be peeling. LPA advised Licensee to repaint the table or remove it from the backyard area. LPA also observed patio chairs to have peeling vinyl. LPA advised Licensee to have patio chairs re-upholstered or replaced.

LPA observed spider webs throughout backyard area. Licensee was advised to have spider webs removed from backyard.

LPA observed backyard fence to have loose panels with nails exposed, LPA advised Licensee to have fence panels secured. LPA also observed some fence panels damaged. LPA advised Licensee to have damaged fence panels replaced.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
Page: 10 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 06/10/2025
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.

Capacity as specified on the license is being maintained.

During inspection, LPA observed that Licensee and assistant did not have proof of completion of Mandated Reporter Training. Licensee and assistant are to complete the Mandated Reporter Training and submit completion certificates to the Department.

Licensee did not have immunization documents available for themself or for assistant (S1). LPA advised Licensee to create a folder for themself as well as assistants to include immunization documents for Measles, Pertussis, Influenza, and TB clearance.

Upon review of Licensee's First Aid/CPR certification, LPA observed that the certificate was not issued by CA EMSA, American Heart Association or by American Red Cross. Licensee is to complete a Pediatric First Aid/CPR training course from an approved course provider and submit completion certificate to the Department.

Upon review of children's documents, LPA observed that immunization documents were missing from children’s files. Licensee is to obtain immunization documents for each child, ensure children are vaccinated for Measles and Pertussis, and place immunization documents in each child’s folder.

LPA also observed that Children’s emergency forms were incomplete or missing signatures. Licensee is to ensure all children's documents are completed and signed.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
Page: 11 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 06/10/2025
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During the inspection, Licensee disclosed that an adult associated to the facility (A1) has been living in the home since 2023. Licensee stated that they did not notify the Department or have the adult fingerprinted. Records show that the adult does not have a criminal background clearance associated to the facility. LPA informed Licensee that the adult must immediately get fingerprinted and have a criminal background clearance associated to the facility. LPA informed Licensee that a citation and $500.00 civil penalty will be assessed today for violation of regulations. Licensee understands that the adult cannot have any contact with children in care unless they have a criminal background clearance on file, and proper certifications.

Although Licensee is not currently providing care to infants, LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
Page: 12 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PENA, ROBBIN FAMILY CHILD CARE
FACILITY NUMBER: 153909735
VISIT DATE: 06/10/2025
NARRATIVE
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Exit interview conducted and report was reviewed with licensee Robbin Pena. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Licensee was provided appeal rights.

LPA Christopher Burnias informed licensee Robbin Pena that this report dated 06/10/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA Christopher Burnias informed the licensee to provide a copy of this licensing report dated 06/10/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee.

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.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
Page: 13 of 13