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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 165620061
Report Date: 11/15/2023
Date Signed: 11/15/2023 07:12:43 PM

Document Has Been Signed on 11/15/2023 07:12 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, ANA FAMILY CHILD CAREFACILITY NUMBER:
165620061
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/15/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Ana GuiterrezTIME COMPLETED:
12:30 PM
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On November 15, 2023, An unannounced case management inspection was conducted today by Licensing Program Analysts (LPA), Paul Garcia. LPA met with licensee, Ana Guiterrez. The purpose of today's inspection is to conduct a 90 Day follow-up on initial pre-licensing visit that took place on May 28, 2023. This is a single story, three bedrooms and two baths home and children will have access to the living room, play room, sleeping room, hallway bathroom, backyard play area and dinning room. Off-limits rooms are made inaccessible by use of door spinners. Safe toys and cabinets without unsafe items, and a clean and orderly home are all observed. There is no fireplace in the home. Children are supervised when outside in the fenced play area. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Operable fire extinguisher, smoke alarm, carbon monoxide and first aid kit are in place. There are no "bodies of water" or firearms in this home. There is a working telephone and number was verified. Licensee’s CPR and first aid training are current with an expiration date of March 7, 2024. LPA discussed with licensee, fire drills are required to be conducted and documented at least every 6 months. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Background clearances are discussed and licensee understands that the adults living in the home and/or providing care and supervision to children shall be background cleared.

Days and hours of operation are Monday through Friday from 7:30 AM- 5:00 PM and as arranged. No overnight care will be provided.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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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: GUTIERREZ, ANA FAMILY CHILD CARE
FACILITY NUMBER: 165620061
VISIT DATE: 11/15/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA & licensee discussed the Community Care Licensing Website, Lead Safety, and Mandated Reporter Training: LPA and licensee 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. LPA left a copy of A Child Care Provider’s Guide to Safe Sleep.

Per Title 22, Division 12, of the California Code of Regulations, no deficiencies were cited.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE INSPECTION FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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