<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103901414
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:04:30 PM


Document Has Been Signed on 01/20/2023 02:04 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:GOMEZ,CONCEPCIFACILITY NUMBER:
103901414
ADMINISTRATOR:GOMEZ,CONCEPCIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 225-4803
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: 11DATE:
01/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:GOMEZ CONCEPCIONTIME COMPLETED:
02:15 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 01/20/2023, Licensing Program Analysts (LPA) Stephanie Vega-Gonzalez conducted an unannounced case management on this date. This case management is based on the annual inspection conducted on 01/03/2023 that was completed from 1:00PM to 5:15PM. The purpose of the inspection was to inspect the “off-limits” backyard due to pool not meeting Title 22 Regulations during annual inspection on 01/03/2023. On today’s date, LPA met with Licensee Concepcion Gomez and toured the facility, and a census was taken of 11 children in care. Also present were Assistant #1 and Assistant #2.

On today's visit, LPA observed Licensee open the pool gate half-way and around twelve inches, and it was observed that pool gate is self-latching, self-closing and opens away from the swimming pool. Swimming pool is fenced per regulation. There are currently two windows located in Bedroom 3 and Bedroom 4 that open directly to the pool and window alarms were installed. LPA observed that windows alarms were strong. LPA informed Licensee that best practice was to periodically inspect window alarms for functionality. Licensee stated they understood. LPA provided Licensee with a copy of their Pool Waiver that was granted on March 18, 2009. LPA reminded Licensee to keep a copy of her pool waiver in facility and for it to be ready and available for any future inspections.

Effective today, 1/20/2023, the facility may begin using the back yard for day care children.


Exit interview conducted and report was reviewed with Licensee Concepcion Gomez.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited today.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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 1