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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909640
Report Date: 12/17/2024
Date Signed: 12/17/2024 11:25:04 AM

Document Has Been Signed on 12/17/2024 11:25 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:BARAJAS DE CERVANTES, PATRICIA FAMILY CHILD CAREFACILITY NUMBER:
243909640
ADMINISTRATOR/
DIRECTOR:		BARAJAS DE CERVANTES, PATRFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 417-7136
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Patricia Barajas De CervantesTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/17/24, Licensing Program Analyst (LPA) Martha De Haro, conducted an unannounced Annual Random Inspection and was met by Licensee, Patricia Barajas De Cervantes. Licensee is Spanish speaking and LPA assisted with interpretation. The home has working telephone service and LPA confirmed the phone number is 408-417-7136. Licensee’s hours of operation are open seven days a week from 5 am to 11:59 pm.
LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room, kitchen, hall bathroom, and the backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by keeping the doors locked during daycare hours. This is a single story home and there are no stairs in the home. The outdoor play area is located in the backyard. It is fenced and there are no hazards to children present. Licensee stated that there is no swimming pool or other body of water on the property, which LPA confirmed via observation. Licensee stated that there are no firearms and ammunition in the home. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The home does not have a fire place or any open face heaters. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. There are 3 dogs in the home. Licensee also has a small calf and some birds in a bird enclosure outdoors. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (Continued on LIC 809-C)
SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Martha DeHaro
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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 12/17/2024 11:25 AM - It Cannot Be Edited


Created By: Martha DeHaro On 12/17/2024 at 10:58 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: BARAJAS DE CERVANTES, PATRICIA FAMILY CHILD CARE
FACILITY NUMBER: 243909640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Licensing Program Analyst (LPA) observed that child #1 was missing the emergency information card as well as all of the required licensing forms, including immunization records. Child #2 was missing immunization records and child #4 was also missing the emergency information card.
POC Due Date: 12/31/2024
Plan of Correction
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Licensee agreed to obtain the missing licensing forms and/or immunization records for child #1, child #2, and child #4. She will send proof to the Community Care Licensing office by the Plan of Correction due date, 12/31/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Martha DeHaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARAJAS DE CERVANTES, PATRICIA FAMILY CHILD CARE
FACILITY NUMBER: 243909640
VISIT DATE: 12/17/2024
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were mostly complete. Licensee agreed to obtain any missing children’s forms from parents as soon as possible. Licensee’s Mandated Reporter Training was completed on 09/25/24. Licensee’s pediatric CPR/First Aid expires on 05/2025.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. (Continued on LIC 809-C)
SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Martha DeHaro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BARAJAS DE CERVANTES, PATRICIA FAMILY CHILD CARE
FACILITY NUMBER: 243909640
VISIT DATE: 12/17/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited during today’s inspection (see LIC 809-D).

Exit interview conducted and report was reviewed with licensee Patricia Barajas De Cervantes.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were also given to licensee.
SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Martha DeHaro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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