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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243800115
Report Date: 04/11/2023
Date Signed: 04/11/2023 09:59:29 AM


Document Has Been Signed on 04/11/2023 09:59 AM - 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:MERCEDES FAMILY DAY CARE HOMEFACILITY NUMBER:
243800115
ADMINISTRATOR:RODRIGUEZ, MERCEDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 383-2911
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY:14CENSUS: 0DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mercedes Rodriguez TIME COMPLETED:
10:00 AM
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On 4/11/2023 Licensing Program Manager (LPM) Rene Mancinas and Licensing Program Analyst (LPA) Yesenia Fierro conducted an unannounced case management inspection. LPA Fierro spoke with Licensee Mercedes Rodriguez regarding an incident that occurred on 3/7/2023 in which child #1 opened to the front door to the facility.

On 3/7/2023 child #1 attended the facility for the first day. While licensee was using the restroom, she heard the front door unlock. Licensee immediately exited the restroom to check and observed child #1 had opened the door. Licensee retrieved child #1 and brought him back inside the facility. Licensee immediately informed the parents of the incident to which parent acknowledged that child has a history of opening the front door. Parent apologized for not disclosing this information to licensee at time of enrollment. Licensee also informed the Resource and Referral agency and the Department to report incident.

Licensee has since installed a door alarm on the front door and had parent provide documentation of child’s habit of opening front doors. Child #1 is still enrolled. Licensee has implemented additional supervision and safety precautions to prevent similar incidents from happening.

Per California Code of Regulations Title 22 Division 12 Chapter 3 no citation is being issued today. Notice of Site to be posted for 30 days.

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
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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