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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910105
Report Date: 10/11/2021
Date Signed: 10/11/2021 11:36:18 AM

Document Has Been Signed on 10/11/2021 11:36 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:DIAZ, CLEMENTINA FAMILY CHILD CAREFACILITY NUMBER:
543910105
ADMINISTRATOR:DIAZ, CLEMENTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 232-4255
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Diaz, ClementinaTIME COMPLETED:
11:50 AM
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On 10/11/2021 Licensing Program Analyst (LPA) Ruby Ocegueda conducted a case management inspection initiated by the licensee. LPA met with licensee Clementina Diaz, toured the facility and took a census. Also present was licensee’s assistants Staff #1 and Staff #2 and 6 children. The purpose of today's inspection was to approve the recent conversion of a garage into a day care room. Licensee previously provided a copy of the certificate of completion certifying that all work completed in the garage conversion meets the requirements set forth in the City of Visalia Municipal code. A fire clearance was granted by the local fire authority on 10/1/2021. A certificate of the Fire Safety Inspection Request is on file at the Fresno Child Care Office. The garage conversion/playroom, living room, kitchen and one hall bathroom will serve as the only areas for care. The rest of the home will be made inaccessible by way of a baby gate between the hall way and the rest of home. The converted garage is labeled on the updated facility sketch as the play room. The playroom also has one restroom that has two toilets and one sink for the children to use. The play room also has two ceiling fans, new electric outlets, an electric AC/heater unit on the wall and carpet flooring. LPA observed in the new daycare room; furniture, equipment and toys that are age appropriate. The new daycare room will be accessed through a glass door that connects the accessible living room and the play room. Parents will be able enter the facility through the living room front door or the play room door that are both in the front patio area. There is one door that has access to the inaccessible back yard. LPA reminded licensee and staff #2 to ensure children did not go to the back yard as it was not approved for care. Meals will be prepared in the accessible kitchen and served in kitchen. LPA toured the area and found it to be safe for day care children's use. The new daycare room is approved to be used by the licensee as of 10/11/2021, per Licensee's request.

On 9/20/2021, Licensee submitted updated Facility Sketch, as well as an updated Emergency Disaster Plan to the Fresno Child Care Office.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DIAZ, CLEMENTINA FAMILY CHILD CARE
FACILITY NUMBER: 543910105
VISIT DATE: 10/11/2021
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Also today, LPA observed that the chain link fence that was torn down via a car accident on 7/27/2021 was replaced. The fence was replaced on 9/7/2021. The front yard is now completely enclosed again and ready for use.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies were cited for this case management inspection.

An exit interview was conducted with licensee Clementina Diaz and a copy of this report was provided and discussed. A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
LIC809 (FAS) - (06/04)
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