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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620289
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:52:45 PM

Document Has Been Signed on 11/16/2023 03:52 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:CISNEROS, ANA FAMILY CHILD CAREFACILITY NUMBER:
155620289
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ana CisnerosTIME COMPLETED:
04:10 PM
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On 11/16/23, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Ana Cisneros for a pre-licensing inspection. Applicant, her husband and her adult son reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • This is a single story, four bedrooms and two bathrooms home and children will have access to the living room, living room #2 (day care room), kitchen, dining room, and hallway bathroom. The main entrance to the home’s day care room is through the left side run of the home. Off-limits rooms/ closets are made inaccessible by use of plastic door knob covers and a child proof safety gate.
  • There is a fireplace in the dining room that applicant states it will not be used during day-care hours. There is central air heating/cooling ventilation for safety and comfort.
  • LPA observed in the day care room; children size furniture, safe toys, and books for the children. There is a flat screen television on top of entertainment cabinet. Children will nap in day care room on cots. Infants will nap in play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant’s Pediatric CPR and First Aid certification was completed through EMS Safety with Emergency Medical Services Authority stickers (EMSA) and expires on 3/3/25.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: CISNEROS, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620289
VISIT DATE: 11/16/2023
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  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on 6/22/23.
  • Knives are stored inside a top kitchen in a plastic container. Medications are stored inside a top kitchen cabinet. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof sliding cabinet latch.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There is an in-ground pool that is fenced with black rod iron fencing that is not in accordance with Title 22 Regulations. The gate is not self-latching/self-closing, and does not swing away from the pool and latching device is not located no more than six inches from the top of the gate. LPA also observed three windows from the in-ground pool that have direct access to the body of water.
  • There is one dog that is kept in a the fenced side run of the home. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms in the home. Ammunition and poisons are stored under key locked in accordance with Title 22 Regulations.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard has a cemented area and a patio porch for shade for the children.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CISNEROS, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620289
VISIT DATE: 11/16/2023
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  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on 4/4/23.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 4:00 AM to 4:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



Applicant is advised the following items must be corrected and a second prelicensing within the next 30 days to avoid possible withdraw.
  • LPA observed that the gate is not self-latching/self-closing, and does not swing away from the pool and latching device is not located no more than six inches from the top of the gate. Applicant will ensure that the pool fence and gate is in compliance with Title 22 Regulations.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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: CISNEROS, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620289
VISIT DATE: 11/16/2023
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  • LPA also observed three windows from the in-ground pool that have direct access to the body of water. Applicant will barricade the access from side run of the home where the three windows are located.
  • LPA will make the PG & E meter that is located on the left side run of the home inaccessible to the day care children.

Pending verification of corrections of the above items and a second prelicensing inspection, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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