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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902921
Report Date: 08/18/2022
Date Signed: 08/18/2022 01:51:06 PM


Document Has Been Signed on 08/18/2022 01:51 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: 7DATE:
08/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Marcela Chavez - Licensee TIME COMPLETED:
02:05 PM
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On 8/18/22, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Marcela Chavez to review POCs associated to deficiencies cited on 7/07/22. Today, LPA verified the following:
  • Licensee maintains a completed Children’s Roster on file
  • Licensee has completed and logged a fire & disaster drill
  • Licensee maintains Emergency Medical Information for children in care
  • Licensee maintains Liability Insurance Affidavits on file for children in care
  • Licensee maintains proof of immunization for children in care within the Family Child Care Home
  • Licensee maintains proof of providing parents with a copy of the Family Child Care Home Notification of Parent's Rights, LIC 995A, the Caregiver Background Check Process, LIC 995E, and the Family child Care Consumer Awareness Information, LIC 9212 information
  • Licensee maintains proof of immunization for for herself, Staff #2, Staff #3, Staff #4 within the Family Child Care Home (FCCH)
  • Licensee completed Mandated Reporter training on 7/28/2022; Staff #2 completed Mandated Reporter training on 7/28/22; Staff #3 completed Mandated Reporter training on 7/28/22; Staff #4 completed Mandated Reporter training on 7/28/22

LPA cleared deficiencies on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for reviewed.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

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: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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