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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 545620048
Report Date: 09/12/2022
Date Signed: 09/13/2022 09:07:43 PM

Document Has Been Signed on 09/13/2022 09:07 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:RODRIGUEZ, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
545620048
ADMINISTRATOR:RODRIGUEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 920-7216
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
09/12/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Elizabeth RodriguezTIME COMPLETED:
01:45 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On September 12, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Elizabeth Rodriguez for a pre-licensing/change of location inspection. Applicant, her Domestic Partner and two adult children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on September 7, 2022.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on September 8, 2022. Fire pull alarm is located on the home’s hallway on the left hand side wall.
  • This is a single story, four bedrooms and three bathrooms home and children will have access to the living room, family room, dining room, bedroom #2 and hallway bathroom. Off-limits rooms are made inaccessible by use of child proof safety gates and key locks.
  • There is a fireplace in the family room that applicant states it will not be used during day-care hours.
  • LPA observed children size furniture, safe toys, and books for the children. Children will nap in living room on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times.
  • Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 545620048
VISIT DATE: 09/12/2022
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  • Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on August 4, 2023. Applicant’s Assistant, Courtney Watson’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on August 26, 2024.
  • Preventative Health and Safety with Prevention of Lead exposure certification is scheduled to be updated.
  • Knives are stored in the kitchen counter and medications are stored inside a top kitchen cabinet. Cleaning compounds are stored in the cabinet that are located underneath the kitchen sink. The kitchen is made inaccessible by the use of a child proof safety gates.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There is an in-ground pool that is fenced with black rod iron fencing in accordance with Title 22 Regulations. The gate is self-latching/self-closing, swings away from the pool and latching device is located no more than six inches from the top of the gate.
  • There is a dog and two cats that are kept in inaccessible bedrooms. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are kept locked inside a tool shed that is located in the garage.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 545620048
VISIT DATE: 09/12/2022
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  • Applicant states she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard has a cemented and sodded area for the day care children. LPA observed a APC Play structure for ages 2-5 years with regulation bark for cushion. A Little Tikes play house, slide structure, and kitchenette. LPA also observed a teeter-totter, a heavy duty swing set, a tether ball,
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on March 27, 2023. Applicant’s Assistant completed the training on December 12, 2023.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 6:00 AM to 6:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.


(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 545620048
VISIT DATE: 09/12/2022
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Provisional License for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification. Provisional license will be effective September 13, 2022.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC809 (FAS) - (06/04)
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