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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909806
Report Date: 11/27/2023
Date Signed: 11/27/2023 03:35:00 PM


Document Has Been Signed on 11/27/2023 03:35 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:RODRIGUEZ, ANDREA FAMILY CHILD CAREFACILITY NUMBER:
103909806
ADMINISTRATOR:RODRIGUEZ, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 399-6160
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:14CENSUS: 10DATE:
11/27/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Andrea RodriguezTIME COMPLETED:
04:00 PM
NARRATIVE
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On 11/27/2023 Licensing Program Analyst (LPA), Pa Kou Vue conducted an unannounced Annual Required Inspection and was met by Licensee Andrea Rodriguez. Also present was licensee’s adult daughter and licensee’s assistant.

The home has working telephone service and LPA confirmed the phone number is (559) 399-6160.

Days and hours of operation are Monday to Friday, 6:00AM – 6:00PM and weekends as needed. .

LPA toured the home inside and outside and a census was taken and there were 10 children. Capacity as specified on the license is being maintained.

This is a two-story home and stairs are gated when children under age 5 years old are present. LPA reviewed current facility sketch (LIC 999A) and Licensee confirmed that the great room, kitchen, dining room, bedroom #4 and bathroom #3 are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by safety latches and doorknob spinners. LPA observed in accessible kitchen counters 6 kitchen knives, ACDelco heavy duty double A batteries, scissors and in accessible kitchen drawer was a screwdriver, a BIC lighter, corkscrew and butter knives. In pantry were 4 opened liquor bottles (2 bottles of 1.75 Liter Kirkland Tequila Blanco, 1 bottle of 1.75-liter Kirkland Vodka and 1 bottle of Grand Marnier Liqueur). Lastly, on kitchen floors next to island were 2 36 pack Bud light Beer cans.

There is no swimming pool or other bodies of water on the premises.

Licensee stated, there are no firearms or ammunition on the premises.

Licensee stated there are no poisons stored on the premise. No poisons were observed during the inspection.

Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home.

(Continued on 809-C)

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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 11/27/2023 03:35 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation in accessible kitchen counters 6 kitchen knives, ACDelco heavy duty double A batteries, scissors and in kitchen drawer was a screwdriver, a BIC lighter, corkscrew and butter knives. In pantry were 4 opened liquor bottles (2 bottles of 1.75 Liter Kirkland Tequila Blanco, 1 bottle of 1.75-liter Kirkland Vodka and 1 bottle of Grand Marnier Liqueur). On kitchen floors next to island there were 2 36 pack Budlight Beer cans.the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2023
Plan of Correction
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Licensee immediately removed products. Licensee and assistants will review CCR 102417(g) and submit a statement of understanding including a statement on how to prevent this in the future. Statements will be submitted to LPA via email end of work day, 11/28/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/27/2023 03:35 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA records review and Licensee interview, Licensee stated she does not have a current fire drill documented. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2023
Plan of Correction
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Licensee stated she will submit a current fire drill and document the drill. A copy of the fire drill will be sent to LPA via email end of work day, 12/01/2023.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA records review and Licensee interview, Licensee does not have Mandated Reporter AB1207 in file and staff #2 is missing LIC503, LIC9052, LIC9108, Immunization Records (MMR, Tdap, TB, PPD, 2023 flu vaccine and Mandated Reporter Training Certificate). The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2023
Plan of Correction
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Licensee stated she will submit the above documents to LPA via email end of work day, 12/01/2023.
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: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/27/2023 03:35 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA children's records review and Licensee interview, child #1 is missing LIC613A, LIC995, LIC9227, LIC700 and 15 minute sleep logs, child #2 is missing LIC613A, child #3 is missing LIC613A, child #4 is missing LIC613A and LIC627 and child #5 is missing LIC613A. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2023
Plan of Correction
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Licensee stated she will submit the above documents to LPA via email by end of work day, 12/012023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806
VISIT DATE: 11/27/2023
NARRATIVE
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There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. The outdoor play area in the backyard is fenced and there are no hazards to children present. Safe toys and play equipment are observed.

LPA reviewed a sample of children’s files and observed files were not complete with emergency information as required. Through LPA children’s records review and Licensee interview, child #1 is missing LIC613A, LIC995, LIC9227, LIC700 and 15-minute sleep logs, child #2 is missing LIC613A, child #3 is missing LIC613A, child #4 is missing LIC613A and LIC627 and child #5 is missing LIC613A.

Licensee’s Mandated Reporter Training expired on 04/26/2023. Licensee’s pediatric CPR/First Aid certification expires on 08/26/2025. A review of records indicates that all employees and/or volunteers does not have immunization records on file for influenza, pertussis, and measles. Through LPA staff records review and Licensee interview, Licensee confirmed that Licensee does not have Mandated Reporter AB1207 in file and staff #2 is missing LIC503, LIC9052, LIC9108, Immunization Records (MMR, Tdap, TB, PPD, 2023 flu vaccine) and Mandated Reporter Training Certificate.

Licensee stated she does not have documentation of fire drills. Licensee was reminded fire drills are conducted every 6 months, must be documented and made readily available to Child Care Licensing.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed large family childcare home single action door handle requirements per PIN 23-11-CCP.

LPA discussed safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

(Continued on 809-C).

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 103909806
VISIT DATE: 11/27/2023
NARRATIVE
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LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Licensee. During the exit interview, the Licensee stated that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Licensee was provided appeal rights.

Upon receipt of a Type A violation, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be 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: Pa Kou VueTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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