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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902186
Report Date: 10/27/2023
Date Signed: 11/13/2023 01:46:53 PM


Document Has Been Signed on 11/13/2023 01:46 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MARTINEZ, ANA & TERESA FAMILY CHILD CAREFACILITY NUMBER:
153902186
ADMINISTRATOR:MARTINEZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 835-9904
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 4DATE:
10/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Ana MartinezTIME COMPLETED:
12:55 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 10/27/2023, Licensing Program Analyst (LPA), L. Cabrera conducted an unannounced Annual Required Inspection and was met by Ana Martinez. Days and hours of operation are Sunday through Saturday, less than 24 hours daily per child.

LPA toured the home inside and outside and a census was taken. LPA reviewed current facility sketch and confirmed that the kitchen, bathroom, den, living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of door knob spinners.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. LPA observed cleaning supplies and chemicals in the hallway closet. The hallway closet door is broken, which made the items accessible to the children. LPA observed a polish and granite cleaner spray underneath the unlocked kitchen sink cabinet. The Licensee immediately removed all items to make it inaccessible to the children.

The fireplace located in the den is made inaccessible by barricade and will not be in use during day-care hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

This is a single level home and there are no stairs. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (661) 835-9904.

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. Licensee reported that the children are not going outside due to weather conditions. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed some documents were missing. Licensee was unable to provide LPA with proof of Mandated Reporter course completion for Staff #1 and Staff #2. Licensee’s pediatric CPR/First Aid certification expires on 04/2025.

SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
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 5


Document Has Been Signed on 11/13/2023 01:46 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations, the licensee did not comply with the section cited above. LPA observed cleaning supplies and chemicals in the hallway closet. The hallway closet door is broken, which made the items accessible to the children. LPA observed a polish and granite cleaner underneath the unlocked kitchen sink cabinet, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/27/2023
Plan of Correction
1
2
3
4
The Licensee immediately removed all items to make it inaccessible to the children.

POC Cleared at visit.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review, the licensee did not comply with the section cited above. During today's inspection, Licensee was unable to provide LPA with proof of Mandated Reporter course completion for Staff #1 and Staff #2. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
1
2
3
4
Licensee will provide proof of completion of the Mandated Reported course to Community Care Licensing by 11/03/2023.
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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 11/13/2023 01:46 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

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
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. Licensee had missing documents for Child #1 (Consent to Emergency medical Care form LIC627), Child #3 (immunization records) and Child #4 missing required documents, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
1
2
3
4
Licensee stated she will completed LIC627 for Child #1 and keep the form in facility file, she will obtain immunization records for Child #3 and will create a file with required documents for Child #4. Licensee is to submit a copy to the Fresno CCL office by 11/03/2023.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. Child #3 is missing Individual Infant Sleeping Plan LIC 9227, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
1
2
3
4
LPA provided licensee a blank form LIC9227 during today's visit. Licensee stated she will complete LIC9227 for Child #3. Licensee to submit a copy to the Fresno CCL office by 11/03/2023.
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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186
VISIT DATE: 10/27/2023
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
26
27
28
29
30
31
32
A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Staff #2 did not contain verification of the required immunization and/or a written statement declining the influenza shot.

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).

Ana Martinez 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 Ana Martinez 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 Ana Martinez 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 Ana Martinez 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.

SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186
VISIT DATE: 10/27/2023
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
26
27
28
29
30
31
32
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 Ana Martinez. During the exit interview, the licensee Ana Martinez 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 deficiencies are being cited: (see next page). Licensee Ana Martinez 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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5