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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243908537
Report Date: 09/18/2024
Date Signed: 09/18/2024 11:47:37 AM

Document Has Been Signed on 09/18/2024 11:47 AM - 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SALAZAR, MARIA & MIGUEL FCCFACILITY NUMBER:
243908537
ADMINISTRATOR/
DIRECTOR:		SALAZAR, MARIA & MIGUELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 777-2928
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Maria Salazar, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 09/18/2024, Licensing Program Analyst (LPA) KA Vang conducted an unannounced case management-other inspection. LPA toured the facility indoor and outdoor, and a census was taken. LPA met with Licensee Maria Salazar and explained the purpose of today's inspection was to discuss the amended LIC809 and LIC809-D pages.

On 04/03/2024, an unannounced annual inspection was conducted, and a deficiency was cited. Per administrative review, the deficiency was determined to be dismissed. LPA amended the LIC809 and LIC809-D pages. During this inspection, LPA completed the new LIC809 and LIC809-D pages with the new deficiency of Type B as Licensees provided evidence that they have made attempts to have the adult household member completed a background clearance to be associated with this facility. During today’s inspection, LPA provided the amended report and the new report to Licensees Maria Salazar.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, a deficiency is being cited during today’s inspection. (See LIC809-D page)

Licensee Maria Salazar was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Maria Salazar.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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 09/18/2024 11:47 AM - It Cannot Be Edited


Created By: Ka Vang On 09/18/2024 at 11:12 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: SALAZAR, MARIA & MIGUEL FCC
FACILITY NUMBER: 243908537

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
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On 05/09/2024, Licensees submitted proof indicated that the adult household member have been cleared of criminal background as of 04/05/2024.
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Based on interview and record review, the licensees did not compliance with the section cited above. LPA observed an adult household member (Staff #3(S3) live in the home with no background clearance associated with this facility. Licensees provided evidence that they have made attempts to have S3’s fingerprint background cleared. This poses a potential health, safety, or personal rights risk to children in care. *This is an amended report.”
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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:Kari McWilliams
LICENSING EVALUATOR NAME:Ka Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024


LIC809 (FAS) - (06/04)
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