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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911934
Report Date: 12/27/2022
Date Signed: 12/27/2022 10:55:32 AM

Document Has Been Signed on 12/27/2022 10:55 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GONZALEZ ACOSTA, LUZ FAMILY CHILD CAREFACILITY NUMBER:
243911934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Luz Gonzalez AcostaTIME COMPLETED:
11:00 AM
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On 12/27/2022 a planned Pre-licensing inspection was made today by Licensing Program Analysts (LPAs) Rene Mancinas and Denisia Jimenez, who met with Applicant, Luz Gonzalez Acosta. A tour of the home, inside and outside, as shown on the facility sketch was done. The areas of the home that day-care children will have access to are the living room and hallway restroom. The remainder of the home is off limits and made inaccessible by child safety devices (i.e. safety latches and/or plastic doorknob spinners and/or safety gates). Backyard is off-limits. Applicant was advised to notify the Department of any changes regarding accessible and inaccessible areas. Applicant and one other adult are the only adults that reside in the home. Background clearances were reviewed and verified. LPA observed safe indoor play areas, child safety plugs in unused electrical outlets, were all observed. Smoke detectors, carbon monoxide detectors, fire extinguisher, and first aid kit are operable and in place. There are no bodies of water at this home. First Aid/CPR are current and expire on 08/13/2024. Child Abuse Mandated Reporter training was completed on 07/12/2022. LPA discussed the practice of fire and disaster drills at least every 6 months and to document the date, time and number of children present. There is a pet at the home. Applicant understands the responsibility of any action taken by pet involving day care children.

Incidental Medical Services (IMS) policy were 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

(Continued on 809-C)

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2022
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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GONZALEZ ACOSTA, LUZ FAMILY CHILD CARE
FACILITY NUMBER: 243911934
VISIT DATE: 12/27/2022
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Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicants 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

The following item is pending and/or needs to be corrected prior to licensure for a small Family Child Care Home, capacity of eight children * ages under 18 years* to be granted. Planned hours of operation are Monday from 12:00AM – Friday at 12:00 AM, and as arranged. License effective date to be determined based upon below correction completed. A second pre-licensing inspection will be conducted to verify proof of correction.

1. There is a pellet gun with lead pellets located at this home. Applicant stated it would be removed from the home within 30 days. LPA advised firearms and ammunition need to be locked and stored separately as required per regulations.

Exit interview conducted and report was reviewed with the applicant.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022
LIC809 (FAS) - (06/04)
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