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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908835
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:30:07 PM


Document Has Been Signed on 10/17/2023 02:30 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:OCHOA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
103908835
ADMINISTRATOR:OCHOA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 999-7555
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY:14CENSUS: 4DATE:
10/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria OchoaTIME COMPLETED:
02:45 PM
NARRATIVE
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On 10/17/2023, an unannounced case management - incident inspection is made today by Licensing Program Analyst (LPA) Gloria Reyes. LPA met with Licensee, Maria Ochoa who is Spanish speaking. Also, present was licensee's spouse. LPA toured the facility inside and outside. A census is taken.

The purpose of today's visit is to discuss reporting requirements. LPA provided the licensee with a copy of the following regulations: Reporting Requirements and a copy of the Unusual Incident/Injury Report (LIC 624B). Licensee is informed that she is being cited for Reporting Requirements for failing to report an incident that occurred on 10/09/23. Licensee said that she sent the LIC 624B to licensing by email on 10/16/23. Licensee stated that she understands when she is to report an unusual incident to licensing.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, a deficiency is cited.



An exit interview was conducted with Licensee, Maria Ochoa. A copy of the appeal rights was provided.
A Notice of Site Visit Form is posted to parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023
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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Document Has Been Signed on 10/17/2023 02:30 PM - 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: OCHOA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 103908835

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2023
Section Cited
CCR
102416.2(b)(3)(C)

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The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (3)(C) Any unusual incident or child absence
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Licensee sent the Unusual Incident/Injury Report (624B) via email on 10/16/23 to licensing.
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or safety of any child." This requirement was not met as evidenced by Licensee failing to report the unusual incident (between child 1 and child 2) to CCL within the CCL regulation specified times. This poses a potential risk to the health, safety, or personal rights of children 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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023
LIC809 (FAS) - (06/04)
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