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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911422
Report Date: 02/21/2023
Date Signed: 02/21/2023 12:17:57 PM

Document Has Been Signed on 02/21/2023 12:17 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:ZARAGOZA, LORENA FAMILY CHILD CAREFACILITY NUMBER:
503911422
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Lorena ZaragozaTIME COMPLETED:
12:30 PM
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On 02/21/23 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensee, Lorena Zaragoza. The hours of operation are Monday through Friday hours are 5:00 AM to 7:00 PM.

LPA toured the home inside and outside. Licensee had 2 children in care 3 children enrolled. Licensee confirmed that the downstairs playroom, and bedroom 2, and bathroom, and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of spinner knobs. LPA provided information and regulation regarding installation of an swimming pool. Swimming pools must be fenced per regulation and inspected by LPA. There are no firearms or ammunition on the premises. Detergents, poisons, cleaning compounds, medication and other hazardous items were inaccessible to daycare children.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are stairs in the home with safety gates. There is a fireplace in the home in an off limits room and not used during daycare hours. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (510) 388-7607 or (510) 501-5182

There are is 1 infants enrolled. LPA discussed Safe Sleep Regulations with licensee. There should be one crib or play yard for each infant in care. Cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. LPA advised the provider who physically checks on sleeping infants every fifteen minutes have documentation easily available for any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Infants up to 12 months of age are placed on their backs for sleeping. Licensee understands the use of the Infant Sleep LIC9227 form. Continue 809C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ZARAGOZA, LORENA FAMILY CHILD CARE
FACILITY NUMBER: 503911422
VISIT DATE: 02/21/2023
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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. The outdoor play area in the backyard is fenced. LPA discussed best practice to do a clean up to assure outdoor areas are clean and safe for children to use. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with the immunizations. Licensee and assistant completed the Mandated Reporter Training on 10/12/22. Licensee and assistant has their pediatric CPR/First Aid expires on 02/2025. Licensee and assistant has evidence of immunization records on file for influenza, pertussis and measles iat the facility.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, No deficiencies cited during today’s inspection. Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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