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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910980
Report Date: 03/20/2023
Date Signed: 03/20/2023 02:11:24 PM

Document Has Been Signed on 03/20/2023 02:11 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910980
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-0174
CITY:SANTA NELLASTATE: CAZIP CODE:
95322
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Maria HernandezTIME COMPLETED:
02:30 PM
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On this date 3/20/2023, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Julie Baptista. LPA met with Licensee Maria Hernandez to review the POCs associated to deficiencies cited on 2/21/2023. LPA took a census. LPA observed hallway for clothing or other items and tables in play area. LPA also reviewed mandatory pediatric CPR/1st aid documentation to ensure the deficiencies were corrected. Today, LPA verified the following:

· LPA observed hallway to be cleared and free of clothing on the floor and there were no boxes obstructing area to the restroom. Table in the children’s play area did not have any food or left over trash and had been cleaned.

· Licensee provided completion certificate of in-person pediatric cardiopulmonary resuscitation and pediatric first aid class taken on 3/11/2023.

LPA cleared deficiencies on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Julie Baptista
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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