103910754-12-27-2023-04-CC-SVGZ-CYWU5D-20231227141633

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103910754
Report Date: 12/27/2023
Date Signed: 12/27/2023 02:16:47 PM

Document Has Been Signed on 12/27/2023 02:16 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	PEREZ, JACQUELINE FAMILY CHILD CARE		FACILITY NUMBER:	103910754
ADMINISTRATOR:	PEREZ, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 375-0269
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	14	CENSUS: 6	DATE:	12/27/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	JACQUELINE PEREZ		TIME COMPLETED:	02:25 PM

NARRATIVE

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On 12/27/2023 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez conducted an unannounced Annual Required Inspection and was met by licensee, Jacqueline Perez. Also present was licensee’s husband who is also the Assistant, and licensee’s older children. Days and hours of operation are Monday through Friday from 6:30am to 5:30pm.

LPA toured the home inside and a census was taken. LPA reviewed current facility sketch and confirmed that the kitchen, dinning area, living room, family room- play area, bedroom 3, bedroom 3’s restroom are used for providing care and are accessible to children. The BACK YARD is OFF LIMITS to children in care and is made inaccessible by an lock door. Licensee understands that she will need to contact Community Care Licensing (CCL) prior to making the backyard accessible to children in care. All other rooms are off-limits and made inaccessible by the use of a baby gate and door knob locks.

There is no swimming pool on the premises. LPA observed that licensee had three water fountains in the front of the home. LPA observed that there was less than an inch of water in two of the fountains. LPA observed as Licensee’s husband removed water from the fountains. Licensee stated that she will ensure to remove any collected water in the fountains. LPA reviewed bodies of water regulations with licensee.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. LPA observed two small dogs. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

There is one fireplace in the home located in the living room and is made inaccessible by a metal gate and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

(Continue on LIC809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

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 12/27/2023 02:16 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PEREZ, JACQUELINE FAMILY CHILD CARE	FACILITY NUMBER: 103910754
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(5)

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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that LPA observed that Licensee had three fountains in the front of the house. LPA observed water that was less than an inch collected in two fountains. LPA observed that Licensee's husband removed water that was collected in fountains, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/10/2024
	Plan of Correction
1 2 3 4	Licnesee stated that she ensures that water will be dumped out of fountains if they get filled by any water. Licensee stated that fountains will be filled with rocks or removed. Licensee stated that she will provide proof of corrections via photos to the Department by POC due date of 01/10/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC809 (FAS) - (06/04)

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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: PEREZ, JACQUELINE FAMILY CHILD CARE	FACILITY NUMBER: 103910754
	VISIT DATE: 12/27/2023

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This is a two-story home and stairs are gated when children under the age of 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 375-0269.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 03/03/2022. Licensee’s pediatric CPR/First Aid certification expires on 03/05/2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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, Jacqueline Perez 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 safe sleep regulations with licensee, Jacqueline Perez 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. LPA also informed licensee, Jacqueline Perez 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.

(Continue on LIC809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: PEREZ, JACQUELINE FAMILY CHILD CARE	FACILITY NUMBER: 103910754
	VISIT DATE: 12/27/2023

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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, Jacqueline Perez 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, Jacqueline Perez During the exit interview, the licensee, Jacqueline Perez confirmed 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 deficiency is being cited: (see next page).

Licensee, Jacqueline Perez was provided appeal rights.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC809 (FAS) - (06/04)

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