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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902921
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:30:35 PM


Document Has Been Signed on 07/07/2022 03:30 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CHAVEZ, MARCELA FAMILY CHILD CAREFACILITY NUMBER:
153902921
ADMINISTRATOR:CHAVEZ, MARCELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 746-9345
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:14CENSUS: 10DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Marcela Chavez - Licensee TIME COMPLETED:
03:50 PM
NARRATIVE
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On 7/7/2022 Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Annual Required Inspection. LPA was met by Licensee Marcela Chavez. Also present was Staff #2 (S2) and Staff #3 (S3). Days and hours of operation are Monday through Sunday, 5:00 AM – 5:00 PM and other hours as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the bathroom, bonus room and playroom/downstairs bedroom are used for providing care and are accessible to children. All other rooms are made inaccessible by use of safety latches on the door and baby gates. There is no swimming pool or other bodies of water on the premises. 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. There is a fireplace in the home that is in an off-limits room and is not used during day-care hours.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are fenced or barricaded when children under age 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 (661) 746-9345

There are currently no infants in care. LPA discussed the 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 -and-resources/safe-sleep as an additional resource. 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. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children (continued of LIC809C).

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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 6


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: CHAVEZ, MARCELA FAMILY CHILD CARE
FACILITY NUMBER: 153902921
VISIT DATE: 07/07/2022
NARRATIVE
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The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. Licensee’s Children’s Roster is incomplete. Licensee has not documented a fire and disaster drill since August of 2020. LPA reviewed a sample of children’s files and observed that 4 of 10 files reviewed did not contain emergency medical information, proof of immunization, and notification of parent’s rights forms. Licensee was unable to provide proof of Mandated Reporter Training completion for herself, S2 and S3. Licensee’s pediatric CPR/First Aid expires on 1/03/23. Licensee does not have records on file, within the facility, of pertussis and measles immunization for herself, S2 and S3. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD).

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 07/07/2022 03:30 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, MARCELA FAMILY CHILD CARE
FACILITY NUMBER: 153902921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

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 records review, the licensee did not comply with the section cited above, as today, she was unable to provide proof of fire & disaster drill completion. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated that she will conduct and document a fire & disaster drill by 8/07/2022. Licensee stated that going forward, she will leave her fire and disaster drill log posted to serve as a visual reminder of the requirement. A return visit will be made by LPA after 8/07/22 to ensure the licensee has followed the above measures to correct this deficiency.
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
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Based on record review, the licensee did not comply with the section cited above, as today, Licensee was unable to provide LPA with proof of current Mandated Reporter course completion for herself, S2, and S3. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated that she, S2, and S3 will complete an AB1207 certified Child Abuse Mandated Reporter course. This training can be accessed by logging onto the following website: mandatedreporterca.com. After completion, licensee will maintain proof of certification within the family child care home. A return visit will be made by LPA after 8/07/22 to ensure the licensee has followed the above measures to correct this deficiency.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 07/07/2022 03:30 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, MARCELA FAMILY CHILD CARE
FACILITY NUMBER: 153902921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above, as today, Licensee was unable to provide LPA with proof of measles and whooping cough immunization for herself, S2 and S3. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated that she will obtain proof of measles and whooping cough immunization, for herself, S2, and S3 by 8/07/22. Licensee stated that she understands that proof of immunization is to be stored within the family child care home at all times. A return visit will be made by LPA after 8/07/22 to ensure the licensee has followed the above measures to correct this deficiency.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 10 children's files reviewed which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated she will obtain, and retain on file, completed Identification and Emergency Information (LIC700s)& Consent for Emergency Medical Treatment (LIC627s) for Child #7, Child #8, Child #9, Child #10 by 8/07/22. A return visit will be made by LPA after 8/07/22 to ensure the licensee has followed the above measures to correct this deficiency.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 07/07/2022 03:30 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, MARCELA FAMILY CHILD CARE
FACILITY NUMBER: 153902921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 9 out of 10 children's files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated she will obtain, and retain on file, proof of completed PM286 records for Child #1- Child#9, by 8/07/22. A return visit will be made by LPA after 8/07/2022 to confirm the licensee has followed the measures stated above to correct this deficiency.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 10 children's files reviewed. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated that she will obtain, and maintain on file, completed 995A's for Child #7, Child #8, Child #9, and Child #10. A return visit will be made by LPA after 8/07/2022 to confirm the licensee has followed the measures stated above to correct this deficiency.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 07/07/2022 03:30 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, MARCELA FAMILY CHILD CARE
FACILITY NUMBER: 153902921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the Children's Roster (LIC9040) on file is incomplete. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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Licensee stated that she ensure the facility's Children's Roster is completed in totality by 8/07/22. Licensee stated that she understands that this roster must be updated accordingly. A return visit will be made by LPA after 8/07/2022 to ensure that an updated Children's Roster is on file at the facility.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on records review, the licensee did not comply with the section cited above in 4 out of 10 children's files reviewed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2022
Plan of Correction
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2
3
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Licensee stated that she will obtain, and maintain on file, completed Liability Insurance Affidavits forms for Child #7, Child #8, Child #9, and Child #10. A return visit will be made by LPA after 8/07/2022 to ensure that all forms are on file.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6