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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909735
Report Date: 06/30/2025
Date Signed: 07/01/2025 08:25:00 AM

Document Has Been Signed on 07/01/2025 08:25 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: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: 8DATE:
06/30/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Robbin PenaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 06/30/2025 Licensing Program Analyst (LPA), Christopher Burnias went to the facility for the purpose of a Plan of Correction Inspection. LPA met with Licensee Robbin Pena, toured the home and took a census.

LPA reviewed Plan of Correction requirements with Licensee in reference to citations issued from an Annual Inspection conducted on 06/10/2025.

LPA verified that that following items have been completed by Licensee.

LPA observed that all accessible areas of the home have been cleaned (carpet, floors, doors, walls, cabinets, drawers) and unnecessary items have been moved to an inaccessible part of the home.

LPA observed that the excess water in the backyard has been drained, the backyard area is free of spider webs, the patio furniture has been repainted, damaged fence panels have been replaced, and dog feces have been removed.

LPA observed that Licensee has removed potentially hazardous items previously observed (gas tank, lawn mower, knives, batteries, tools, lighters, makeup, and nail polish) and placed items in an inaccessible area of the home. LPA observed that Licensee has installed drawer and cabinet locks, and LPA reminded Licensee to ensure children do not have access to hazardous items.

LPA verified that Licensee has completed Mandated Reporter Training on 06/24/2025. LPA verified that Assistant 1 (A1) has completed Mandated Reporter Training on 06/24/2025 and that Assistant 2 (A2) has completed Mandated Reporter Training on 06/26/2025.

NAME OF LICENSING PROGRAM MANAGER: Luisa Gavoutian
NAME OF LICENSING PROGRAM ANALYST: Christopher Burnias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2025
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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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: 06/30/2025
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LPA verified that Licensee has completed Pediatric First Aid/CPR Training through the American Heart Association and that their training certificate expires on 06/25/2027. LPA verified that A1 has completed Pediatric First Aid/CPR Training through the American Heart Association and that their training certificate expires on 06/25/2027.

LPA observed that Licensee has created a staff file for themselves, for A1, and A2. LPA observed staff files to contain immunization documents for Measles and Pertussis.

LPA verified that Licensee has reviewed regulations regarding Reporting Requirements. Licensee submitted a written statement indicating they have read and understood the regulations and will ensure the facility will comply with licensing requirements.

Upon review of children’s files, LPA observed that each child’s file includes immunization documents for Measles and Pertussis. LPA also observed that children’s documents are completed and signed.

LPA verified that forms LIC 9224 Acknowledgement of Receipt of Licensing Reports, and LIC 995B FAMILY CHILD CARE HOME ADDENDUM TO NOTIFICATION OF PARENTS’ RIGHTS (REGARDING REMOVAL/EXCLUSION) have been completed and signed for each child in care due to Licensee receiving a Type A citation issued on 06/10/25.

LPA has determined that all Plan of Correction requirements have been met to clear citations originally issued on 06/10/2025.

During inspection, LPA provided Licensee with information regarding the Technical Support Program which assists in providing free training to child care providers. Licensee wishes to enroll in training and LPA will submit a request for enrollment.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, no new deficiencies are cited.

Report was with reviewed with Licensee and appeal rights were provided.

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: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
LIC809 (FAS) - (06/04)
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