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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 11:37:55 AM

Document Has Been Signed on 10/11/2021 11:37 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: 0CENSUS: 6DATE:
10/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Diaz, ClementinaTIME COMPLETED:
11:50 AM
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 On 10/11/2021, Licensing Program Analyst (LPA) conducted a case management inspection for the purpose of addressing requirements for assistants, ratio, supervision requirements and Covid-19 guidance. LPA Ocegueda met with licensee Clementina Diaz, toured the home and a census was taken.

LPA Ocegueda provided licensee with a list of necessary documents that each of her staff should have including First/Aid CPR first aid training if any assistant was to be ever left alone with the children at home or outside of the facility. Licensee can use her child to assist so long as he/she is above the age of 14 years old but should never be left alone with the children. LPA reviewed the requirement for licensee to be present at the facility and indicated to her that “absences should not exceed 20 percent of the hours that the facility is providing care per day”. LPA provided licensee a copy of ratio information to assist her in determine the ages and number of children she can have in care. Licensee understands that she should follow ratio and capacity and supervision requirements at all times.

LPA also discussed Covid-19 guidance. On 7/28/2021, Licensee did not wear a mask while children were in care. LPA reviewed that this was a requirement per the most current guidance from the Department and the California Department of Public Health. LPA provided a copy of the guidance to licensee today. LPA discussed the requirement for licensee to ensure the health and safety of children in care under the personal rights regulations.

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
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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