545620292-11-28-2023-57-CC-NLOI-CXZRLQ-20231128120733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 545620292
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:07:41 PM

Document Has Been Signed on 11/28/2023 12:07 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:	JACUINDE AMBRIZ, GABRIELA FAMILY CHILD CARE		FACILITY NUMBER:	545620292
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/28/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Gabriela Jacuinde Ambriz		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/28/23, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Gabriela Jacuinde Ambriz for a pre-licensing inspection. Applicant, her husband, and one minor child 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. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a single story, three bedrooms and two bathrooms home and children will have access to the living room, dining room (day care room), kitchen and hallway bathroom. Off-limits rooms/ closets are made inaccessible by use of child proof safety gates and plastic door knob covers. There is central air heating/cooling ventilation for safety and comfort. LPA observed in the dining room; children size furniture, safe toys, books and a high chair. There is a flat screen television mounted onto the living room wall. There is a parents board on the right hand side wall of the home's entry way. Children will nap in the living room and dining room on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on 6/12/25. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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 3

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: JACUINDE AMBRIZ, GABRIELA FAMILY CHILD CARE	FACILITY NUMBER: 545620292
	VISIT DATE: 11/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Preventative Health and Safety with Prevention of Lead exposure certification was completed on 7/11/23.
Knives are stored inside a top kitchen cabinet. Medications are stored in the master bedroom closet. Cleaning compounds are stored in the inaccessible garage on a top shelf.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
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 are no bodies of water in the home or premises.
There is a dog that is kept in a fenced area in the backyard. There is a snake inside a terrarium that is locate in a bedroom inaccessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
Firearms are stored in accordance with Title 22 Regulations. Applicant states that there is no ammunition in the home. Poisons are stored locked inside a Rubbermaid shed that is located on the side run of the home.
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.
Applicant states she will 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 children. There is a patio porch for shade. LPA observed a Little Tikes toddler play house, a water table and other safe toys. There is a wooden picnic bench and an infant swing mounted onto the patio porch.
SB 792 immunizations verified and on file.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: JACUINDE AMBRIZ, GABRIELA FAMILY CHILD CARE	FACILITY NUMBER: 545620292
	VISIT DATE: 11/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Applicant completed the Mandated Reporter Training on 5/30/23.
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 5:00 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.

Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.

Applicant will remove protruding screws located in the backyard fence that are sharp and pointy.

Pending verification of correction of the above item and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3