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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203902569
Report Date: 03/05/2024
Date Signed: 03/05/2024 02:52:12 PM


Document Has Been Signed on 03/05/2024 02:52 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:GUZMAN, DOLORES FAMILY CHILD CAREFACILITY NUMBER:
203902569
ADMINISTRATOR:GUZMAN, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-8279
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 3DATE:
03/05/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:GUZMAN, DOLORESTIME COMPLETED:
03:00 PM
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On 3/5/2024 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez conducted an unannounced Annual Required Inspection and was met by licensee Dolores Guzman. Also present was licensee’s husband and licensee’s adult son. Licensee is Spanish Speaking and LPA assisted with interpretation. Days and hours of operation are from Monday through Saturday from 5:00am to 5:30pm.

LPA toured the home inside and outside and a census was taken. LPA reviewed current facility sketch and confirmed that the kitchen, hallway bathroom, living room, dinning room, and side yard are used for providing care and are accessible to children. LPA reviewed regulation 102416.3 Alterations to Existing Buildings or Grounds and PIN 23-20-CCP Required Notification Prior for Making Changes to Child Care Facilities. During today’s inspection LPA was informed that there had been changes to the grounds. LPA observed that a patio porch was added. LPA inspected backyard and found the area to be in good working order. LPA was also informed that there was alterations to the front yard. LPA reviewed regulations and PIN and Licensee understands to communicate with the department before any changes, and once they are completed. All other rooms in the home are off-limits and made inaccessible by use of a baby gate, door knob spinners. LPA reviewed PIN 23-11-CCP 6.19.2023 Large License Single Action Door Handle/ Single Action Lock. Licensee stated she would communicate with the department if she had any follow up questions.



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. LPA observed large dog in a side yard that is inaccessible to children in care. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets.

There are no fireplaces or open face heaters in the home. 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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GUZMAN, DOLORES FAMILY CHILD CARE
FACILITY NUMBER: 203902569
VISIT DATE: 03/05/2024
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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 (559) 675-8279.

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 and there are no hazards to children present. 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 01/30/2024. Licensee’s pediatric CPR/First Aid certification expires on 1/17/2025. 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 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 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 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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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: GUZMAN, DOLORES FAMILY CHILD CARE
FACILITY NUMBER: 203902569
VISIT DATE: 03/05/2024
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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 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 During the exit interview, the licensee 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, no deficiencies are cited.

Licensee 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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
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