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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 165620032
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:04:41 PM

Document Has Been Signed on 08/29/2022 03:04 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:JIMENEZ, BLANCA FAMILY CHILD CAREFACILITY NUMBER:
165620032
ADMINISTRATOR:JIMENEZ, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 904-7451
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
08/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Blanca JimenezTIME COMPLETED:
03:15 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On August 29, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Blanca Jimenez for a pre-licensing/ change of location inspection. Applicant and her adult son reside in the home. LPA verified licensee’s CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on May 2, 2024. Applicant’s Assistant, Andres Pulido completed the training through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on April 23, 2023. 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. Fire clearance was granted on August 27, 2022.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:

  • Fire clearance was received on August 27, 2022. Fire pull alarm is located on the home’s Mother-in-Law suite’s entry way wall.
  • This is a single story, three bedrooms and three bathrooms home and children will have access to the living room, kitchen/dining room, bedroom #1 and bathroom #1 that are both located in the Mother-in-Law suite (day care room). The main entrance door for parents and children will be through the Mother-in-Law suite.
  • Off-limits, closets rooms are made inaccessible by use of plastic door knob covers and child proof safety gates.
  • There is no fireplace in the home.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: JIMENEZ, BLANCA FAMILY CHILD CARE
FACILITY NUMBER: 165620032
VISIT DATE: 08/29/2022
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  • LPA observed in the day care room; children size furniture, safe toys, and books for the children. There are is a diaper changing station, an infant swing and a twin bed in bedroom #1. LPA also observed a parents board on the right hand side of the entry way. Children will nap in the living room/ and in the Mother-in-Law suite bedroom #1 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 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on April 15, 2021.
  • Knives are stored inside a top kitchen cabinet. Medications are stored in the master bedroom closet’s top shelf. Cleaning compounds are stored in the bottom kitchen cabinet made inaccessible by the use of a child proof safety latch and other in the inaccessible laundry room.
  • 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 are no bodies of water in the home or premises.
  • There are two dogs that are kept in inaccessible bedrooms. One dog will be kept in the gated backyard’s side run. 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, ammunition or poisons in the home or premises.
  • 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.

(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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: JIMENEZ, BLANCA FAMILY CHILD CARE
FACILITY NUMBER: 165620032
VISIT DATE: 08/29/2022
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  • 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 an area with dirt and gravel. LPA observed a large canopy for shade. There are tricycles, Little Tikes slide, children size tables and chairs and other safe toys for the day care children.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on May 29, 2022. Applicant’s assistant completed the training on August 29, 2022.
  • 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 Sunday, 24 hours a day. Overnight care will be provided. "Overnight Care" means care being provided to children anytime between the hours of 6:00 PM and 6:00 AM. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care. LPA provided applicant with the overnight care regulations.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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: JIMENEZ, BLANCA FAMILY CHILD CARE
FACILITY NUMBER: 165620032
VISIT DATE: 08/29/2022
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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.

Licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective August 30, 2022.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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