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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620149
Report Date: 07/06/2023
Date Signed: 07/06/2023 01:53:35 PM

Document Has Been Signed on 07/06/2023 01:53 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:VIVAR, JUDITH FAMILY CHILD CAREFACILITY NUMBER:
155620149
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Judith Vivar- LicenseeTIME COMPLETED:
02:05 PM
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On 7/06/23, an unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Judith Vivar and toured the facility. The purpose of today's inspection was to conduct a post licensing follow-up on the pre-licensing inspection that took place on 4/25/23.

The living room, dining room (day care room), kitchen and hallway bathroom are accessible to children. Off-limits rooms are made inaccessible by use of plastic door knob covers. There are no bodies of water or weapons at this residence. Children's files reviewed contained required documentation. LPA discussed with Licensee the requirement of completing a fire and disaster drills every six months. Required forms are posted. Licensee maintains a current Children's Roster. There is one crib or play yard for each infant in care, cribs and play yards are 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. Infants are not swaddled while in care. Licensee physically checks 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. Provider Information Notices were discussed, and licensee is aware that forms and updated information may be obtained on the Department's website (www.ccld.ca.gov). LPA discussed Required 1-Year inspections with the licensee, detailing what to expect. Reporting requirements were discussed and Licensee understands that unusual incidents must be reported the Fresno Community Care Licensing office during the Department's normal business hours, before the close of the next working day following the occurrence.

Facility is operating Monday through Friday, from 7:00 AM to 5:30 PM.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies were cited today. An exit interview was conducted with Licensee and appeal rights were provided.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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