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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911178
Report Date: 05/23/2023
Date Signed: 05/23/2023 12:30:44 PM

Document Has Been Signed on 05/23/2023 12:30 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:GUTIERREZ, NORMA FAMILY CHILD CAREFACILITY NUMBER:
153911178
ADMINISTRATOR:GUTIERREZ, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 340-2874
CITY:BAKERFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Norma Gutierrez- Licensee TIME COMPLETED:
12:40 PM
NARRATIVE
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On 5/23/2023, Licensing Program Analyst (LPA) Jessika Thompson met with Licensee Norma Gutierrez for an unannounced case management inspection. LPA toured the facility and a census was taken.

The purpose of today's inspection was to obtain additional information regarding Adult #1, as information regarding Adult #1 residing on the premises was recently provided to the Department. Today, LPA interviewed the licensee who stated that Adult #1 has been living on the premises, as her tenant, in a detached mother-in-law suite located on the north eastern side of the backyard. During review of records associated to the facility, LPA confirmed that Adult #1 is not fingerprint cleared and associated to the facility as required.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC809 D). Licensee was provided a copy of appeal rights.

LPA informed Licensee that this report dated 5/23/2023, which documents 1 Type A citation 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 Thompson informed the licensee to provide a copy of this licensing report dated 5/23/2023 that documents a 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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted with Licensee and a copy of this report was provided and discussed. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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Document Has Been Signed on 05/23/2023 12:30 PM - It Cannot Be Edited


Created By: Jessika Thompson On 05/23/2023 at 11:50 AM
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: GUTIERREZ, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153911178

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2023
Section Cited
CCR
102370(d)(1)

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(d) 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.
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Licensee stated she will ensure Adult #1 undergoes live scan processing in order to obtain background clearance today. Licensee stated she will submit proof of live scan to the Fresno Community Licensing (CCL) office by 05/24/23. Licensee understands that until background clearance is obtained, Adult #1 is not permitted to reside on the premises.
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This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as today, LPA confirmed that Adult #1 resides on the premises of the FCCH. Upon records review, LPA found that Adult #1 has not obtained criminal background clearance through the Department as required. This poses an immediate health, safety or personal rights risk to persons in care.
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Licensee stated that Adult #1 will vacate the premises today, awaiting fingerprint clearance.

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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.
SUPERVISOR'S NAME:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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