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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900956
Report Date: 12/12/2022
Date Signed: 12/12/2022 11:25:02 AM


Document Has Been Signed on 12/12/2022 11:25 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ALVAREZ,AMALIAFACILITY NUMBER:
103900956
ADMINISTRATOR:ALVAREZ,AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 399-3046
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:14CENSUS: 6DATE:
12/12/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Amalia AlvarezTIME COMPLETED:
11:30 AM
NARRATIVE
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On 12/12/22 Licensing Program Analyst, (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Licensee, Amalia Alvarez and toured the home. A census was taken. Also present was her daughter/assistant, Carol Denbok who helped interpret.

The purpose of the inspection is to clear deficiencies that were previously cited on 8/25/22. LPA reviewed children's files. Children's files were still missing required documentation and were not complete, but the LPA did observe copies of immunization records in each of the children's files. Infant files, showed proof of Individual Sleep Plans in two of three infant files and 15 minute checks in one of three infant files. Upon staff file review, the licensee and her assistant did not have proof of MMR or influenza and the assistant did not have a file. LPA observed keep out of reach items to be inaccessible to children and the licensee purchased tight fitting sheets for the infant cribs.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. Exit interview was conducted with Carol Denbok. Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found during today’s inspection.
A copy of this report along with appeal rights and LIC 9213 Notice of Site Inspection were provided to the licensee, Amalia Alvarez. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2022
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


Document Has Been Signed on 12/12/2022 11:25 AM - It Cannot Be Edited

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: ALVAREZ,AMALIA
FACILITY NUMBER: 103900956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2022
Section Cited

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
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This is a recitation. The licensee agrees to immediately start logging the 15 min check and have the parent complete the individual sleep plan. A return visit will take place in order to clear this deficiency.
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Based on record review, Individual Sleep Plans were in two of three infant files and 15 minute checks in one of three infant files. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
12/27/2022
Section Cited

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(a) Personnel records shall be maintained on each employee and shall contain the following information: Based on records review the licensee did not have files for her assistant with required documentation.
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This is a recitation. The licensee agrees to have complete files for herself and staff available for review by the due date of 12/27/22.
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The licensee also did not have all required documents for herself. This poses a potential health, safety or personal rights risk to persons in care.
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Previously, the licensee agreed to take the child care orientation, but did not complete the training. Information was given to the licensee again, and the licensee agrees to take the orientation by the due date of 12/27/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 12/12/2022 11:25 AM - It Cannot Be Edited

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: ALVAREZ,AMALIA
FACILITY NUMBER: 103900956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2022
Section Cited

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This is a recitation. The licensee agrees to have all required immunizations for her and her helper available for review by the due date of 12/27/22.
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Based on record review, the licensee did not have proof of her MMR or influenza. The licensee's assistant also did not have proof of MMR, or influenza. This poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2022
LIC809 (FAS) - (06/04)
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