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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243800117
Report Date: 07/07/2023
Date Signed: 07/07/2023 04:42:34 PM


Document Has Been Signed on 07/07/2023 04:42 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:CHAVEZ, ELIA FAMILY CHILD CAREFACILITY NUMBER:
243800117
ADMINISTRATOR:CHAVEZ, ELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 358-2745
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:12CENSUS: 11DATE:
07/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Elia and Ruben ChavezTIME COMPLETED:
04:55 PM
NARRATIVE
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On 07/07/2023, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensees Elia Chavez and Ruben Chavez. Days and hours of operation are Monday through Friday, from 7:30 AM-5:30 PM. The home has a working telephone service and LPA confirmed the phone number is (209) 358-2745.

Licensees stated that they provided breakfast, lunch, and snack for the daycare children throughout the day. For the infants, parents provide the infants formula or baby food, and Licensees feed the infants based on parents’ instructions.

LPA toured the home inside. Census was taken and there were eleven daycare children present. Current facility sketch (LIC 999A) was reviewed, and Licensees confirmed that the living room, dining room, and hallway restroom are used for providing childcare and accessible to the daycare children. All other rooms are off-limits and made inaccessible to the daycare children as all doors locked at all times. There is no fireplace in the home. Licensees stated that there are no firearms in the home. Poisons, detergents, and cleaning compounds were observed and are accessible to children in care; therefore, a deficiency of Type B was cited. See attached page LIC 809-D for additional information.

This is a single-story home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills are conducted and documented with the date, time and how many children present, every six months.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There is no animal in the home. The outdoor play area in the backyard is not accessible to the children as the sliding glass door is locked at all times. LPA did not observe an above-ground or in-ground swimming pool.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
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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Document Has Been Signed on 07/07/2023 04:42 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as Staff #3 (S3) who was providing care to the children did not obtain a criminal record clearance or an exemption prior to initial persence in the facility which poses an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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LPA observed S3 immediately left the daycare home. Licensees also agreed to pay the Civil Penalty Assessment-Caregiver Background Check violation of $100 due to S3 did not had criminal record clearance or an exemption. Licensees agrees to submit proof that Licensees will ensure that there shall be no unclear background adults present or provide care for the daycare children. Licensees agree to submit the Proof of Correction (POC) to Community Care Licensing-Fresno Office by 07/14/2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2023 04:42 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensees did not comply with the section cited above. During the indoor inspection, LPA observed two bottles of Raid in the kitchen cabinet that is not locked. LPA observed a bottle of Clorox wipes on the bookshelf, a liquid bottle of Clorox and Pine Sol on the kitchen counter. LPA observed bottles of shampoo in the children's restroom inside the shower which posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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Licensees immediately locked the Raids in the file cabinet in the off limited area. Licensees immediately removed the Clorox wipes and the liquid Clorox and stored in the locked cabinet. Licensees also immediately stored the bottles of shampoo in the shower tub shelf. Licensee will submit proof of how Licensees will ensure that daycare children will not have access to the chemical and cleaning compounds in the daycare. Licensees agrees to submit the proof to CCL-Fresno Office by 07/14/2023.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensees did not comply with the section cited above. LPA observed two play yards in the living rooms. The first play yard has a sleeping child who had three blankets, a small pillow, and a bottle of milk inside the play yard with the child. LPA observed the second play yard has a child who was not sleeping but she was inside the play yard with a blanket and toys. This poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Licensees immediately removed the articles and items from the sleeping child. Licensees agree that they will review the Safe Sleep Regulations and video(s) through the California Department of Social Service Community Care Licensing websit: www.cdss.ca.gov. Licensees will submit proof that they understand the Safe Sleep Regulations.
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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 11


Document Has Been Signed on 07/07/2023 04:42 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the Licensees did not comply with the section cited above. LPA observed Child #1 (C1) was sleeping in the stroller as LPA entered the facility. LPA advised Licensees that if an infant falls sleep before being placed in a play yard, Licensees must move the infant to the play yard as soon as possible. Licensees stated that child had to sleep in the stroller in order for child to fall sleep. LPA observed that through the inspection process, child continued to sleep in the stroller which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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Per Licensees, they agree that they will review the Safe Sleep Regulation and implant a plan to ensure that C1 will not be sleeping in the stroller. Licensees agrees to submit the plan to CCL-Fresno Office by 7/14/2023.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above. Licensees were not able to provide proof of physically check on Child #1 (C1) and Child #5 (C5) every 15 minutes when they were sleeping which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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Per Licensees, they agree that they will submit proof of physically check on C1 and C5 every 15 minutes and submit the 15 minute logs to CCL-Fresno Office by 7/14/2023.
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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 11


Document Has Been Signed on 07/07/2023 04:42 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 licensees did not comply with the section cited above as Staff #2 (S2) did not have proof of completing the mandated reporter training for The General Training (2 hours) and for The Child Care Providers training (4 hours) which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Licensees agreed that S2 will complete the mandated reporter training for The General Training (2 hours) and for The Child Care Providers (4 hours) Training and submit the proof of completion (certificates) to CCL-Fresno Office by 07/21/2023.
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 record review, the licensees did not comply with the section cited above as S2 did not have proof that S2 has all the required immunizations for the MMR, TDap, TB and influenza which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Licensees agreed that S2 will obtain his record for the required immunizations for the MMR, Tdap, TB and the influence and submit the proof to CCL-Fresno Office by 07/21/2023.
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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2023 04:42 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as S1 or S2 have their current pediatric cardiopulmonary resuscitation (CPR) and first aid (FA).
POC Due Date: 07/21/2023
Plan of Correction
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Licensees agreed that S1 and or S2 will complete the CPR/FA training and will submit the proof of completion (certificates) to CCL-Fresno Office by 07/21/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
LIC809 (FAS) - (06/04)
Page: 6 of 11


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: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117
VISIT DATE: 07/07/2023
NARRATIVE
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Licensees were 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. During the inspection, LPA observed Staff #3 was providing care for the daycare children. There was no record indicate that Staff #3 had criminal record clearance. A deficiency of Type A was cited during today’s inspection as it is an immediate risk to the children in care. A civil penalty of $100.00 minimum per day was assessed. See attached page LIC 809-D for additional information.

LPA discussed the safe sleep regulations with licensees 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 licensees 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.



Licensees have two infants enrolled in the facility. Licensees understands that there shall be one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. A deficiency of Type B was cited as the regulation was violated. See attached page LIC 809-D. Infants are not swaddled while in care. Licensees were not able to provide proof of physically checking on infants (Child #1 and Child #5) every fifteen minutes document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a sleeping log. A deficiency of Type B was cited. See attached page LIC 809-D. Licensees understands that infants can be visually observed through an open door if sleeping in a separate room.

Licensees 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. 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 (Staff #1) Mandated Reporter training was completed on 08/24/2021. Licensee (Staff #2) did not have proof of completing Mandated Reporter training. A deficiency of Type B was cited. See attached LIC 809-D page. Licensee (Staff #1) pediatric CPR/First Aid expires on 02/2023. There was no record of Licensee (Staff #2) has current CPR/FA. A deficiency of Type B was cited. See attached LIC 809-D page.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
Page: 10 of 11
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: CHAVEZ, ELIA FAMILY CHILD CARE
FACILITY NUMBER: 243800117
VISIT DATE: 07/07/2023
NARRATIVE
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 A review of records indicates that Licensee (Staff #1) has immunization records on file for influenza, pertussis, and measles. A review of records indicated that Licensee (Staff #2) did not have immunization records on file for influenza, pertussis, and measles. A deficiency of Type B was cited. See attached LIC 809-D page.

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/.

LPA and Licensees 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.



Licensees were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care 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.

Per the California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiencies are being cited during today’s inspection. (See next page, LIC809-D).

Upon receipt of a Type A violation, licensees shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet-Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensees.

Licensees were provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensees Elia Chavez and Ruben Chavez. During the exit interview, Licensees Elia Chavez and Ruben Chavez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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