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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910093
Report Date: 06/25/2021
Date Signed: 06/25/2021 02:38:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GOMEZ NUNEZ, BERTHA FAMILY CHILD CAREFACILITY NUMBER:
153910093
ADMINISTRATOR:GOMEZ NUNEZ, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 778-6903
CITY:MCFARLANDSTATE: CAZIP CODE:
93250
CAPACITY:14CENSUS: 5DATE:
06/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Bertha Gomez NunezTIME COMPLETED:
02:45 PM
NARRATIVE
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On 06/25/2021 Licensing Program Analysts (LPAs), Rene Mancinas and Araceli Gibson, conducted an unannounced Annual Required Inspection and was met by Licensee, Bertha Gomez Nunez, who is Spanish speaking. LPA Mancinas provided services in Spanish. Days and hours of operation are Monday through Saturday 05:00am to 05:00pm.

LPAs reviewed current facility sketch and LPA’s toured the home inside. Licensee confirmed that living room, kitchen, dining area, children’s restroom, and backyard are accessible for children to use. All other rooms/areas are off-limits and made inaccessible by use of children safety gate/ child proof devices. There is a pet at this home. Licensee understands responsibility of any action taken by pet involving day care children. 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.

There is a fireplace that is made inaccessible to day care children via the use of a screening device. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number.

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. The outdoor play area located on the side of the house is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GOMEZ NUNEZ, BERTHA FAMILY CHILD CARE
FACILITY NUMBER: 153910093
VISIT DATE: 06/25/2021
NARRATIVE
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Licensee currently cares for infants (0-24m). LPA discussed Safe Sleep Regulations with licensee. Licensee understands she is to physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

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 03/14/2020 (and must be renewed every two years). Licensee’s Pediatric CPR is to expire on 09/09/22. 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.

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) and website link https://www.ada.gov/childqanda.htm.

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.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GOMEZ NUNEZ, BERTHA FAMILY CHILD CARE
FACILITY NUMBER: 153910093
VISIT DATE: 06/25/2021
NARRATIVE
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited. (See 809-D for further). Appeal rights were provided.

During inspection of backyard, which children have access to, LPAs observed a shovel and two propane tanks that were not covered, or made inaccessible to children in care. Children were not playing outdoors during today’s inspection. This poses a potential risk to the health, safety, and personal rights of children in care.

During inspection of facility files review, Licensee could not produce proof of infant sleeping checks (every 15 minutes during sleeping/napping periods) as required for infants (0-24m) of age per regulations. LPAs provided licensee with information regarding Safe Sleep regulations and requirements. This poses a potential risk to the health, safety, and personal rights of children in care.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ NUNEZ, BERTHA FAMILY CHILD CARE
FACILITY NUMBER: 153910093
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2021
Section Cited

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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 was not met as
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evidenced during today's inspection of backyard (accessible area to children in care). (See 809-C for further). This poses a potential risk to health, safety, and personal rights of children in care.
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Proof via photos to be submitted to CCLD-Fresno Child Care by POC date.
Type B
06/30/2021
Section Cited

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The provider shall physically check on the infant every 15 minutes. This requirement was not met as evidenced during today's inspection of facility file review. (See 809-C for further). This poses a potential risk
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to the health, safety, and personal rights of children in care.
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will complete and document checks as soon as possible, and submit proof to CCLD-Fresno Child Care by POC date.
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: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4