243809958-9-8-2023-04-CC-MHEA-CVGL6Y-20230908082927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243809958
Report Date: 09/07/2023
Date Signed: 09/08/2023 08:29:34 AM

Document Has Been Signed on 09/08/2023 08:29 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GOMEZ, BERTHA FCC		FACILITY NUMBER:	243809958
ADMINISTRATOR:	GOMEZ, BERTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 382-2612
CITY:	PLANADA	STATE: CA	ZIP CODE:	95365
CAPACITY:	14	CENSUS: 3	DATE:	09/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Bertha Gomez		TIME COMPLETED:	01:10 PM

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On September 7, 2023, Licensing Program Analyst (LPA), Migue Herrera conducted an unannounced Annual Required Inspection and was met by Licensee Bertha Gomez. Licensee is Spanish Speaking and LPA Herrera was able to communicate with licensee in Spanish. Days and hours of operation are Monday through Friday, 5:30AM through 5:30PM. The home has working telephone service and LPA confirmed the phone number is 209-564-0822.

LPA toured the home inside and outside and a census was taken. LPA Herrera conducted a census and there are 3 children in the home with Licensee, 1 of the children at the home is an infant. Capacity as specified on the license is being maintained. 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. LPA reviewed current facility sketch with licensee and confirmed that the daycare room, daycare restroom, and daycare kitchen are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by lock and key, and door knob spinners. LPA Herrera observed the addition next to the daycare room. Licensee stated the room has yet to be permitted. The room leads to an outdoor area that is completely fenced in. LPA did not observe any toys, or items that would suggest the room and the outdoor area to be in use for childcare. Licensee states that the addition located by the daycare room is off-limits to children and are not used to provide care. Licensee understands that she must receive proper clearance if she intends to use the rooms for providing care in the future.

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. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher located in the daycare kitchen. The smoke detector and carbon monoxide detector are in working conditions and are located in the daycare room. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. There is adequate heating and ventilation for safety and comfort of the children. LPA was able to observe fire drill documentation with the date, time and how many children present, at least every six months. Licensee has a current roster of the children. (Continued on 809-C.)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 09/07/2023

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This is a single level home and there are no stairs. During the inspection, LPA observed safe toys and play equipment in the daycare room. LPA did not observe any hazardous items in the daycare kitchen. The daycare bathroom used by children was observed to be free from hazards.

LPAs observed 2 dogs in the outdoor dog run located in the backyard. The dog run was fenced and the gate was closed with a latch. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets. The outdoor play area in the backyard is fenced. LPA advised for licensee to conduct frequent safety inspections of the play structure to check for any loose parts, cracks, and hazards. Licensee is aware of child safety around the play structure and assumes all responsibility. Licensee ensures that children in care are always supervised. As best practice, LPA advised Licensee to continue to monitor and clean play structures/toys from insects and other debris. LPA Herrera also observed the patio area leading directly to the daycare room and did not observe any hazardous items. Licensee states she uses the patio as an outdoor play area and ensures she supervises the children at all times since it leads to the front yard.

LPA reviewed a sample of children’s files and observed files were complete with the immunizations and required documentation. Licensee’s Mandated Reporter Training expires on 03/11/2024. Licensee’s pediatric CPR/First Aid certification expires on 12/18/2023. A review of records indicates that licensee has immunization records on file for influenza, pertussis, and measles. Currently Licensee has an Assistant. Licensee was able to produce Assistant’s complete immunization records with Tuberculosis clearance. Assistant’s Mandated Reporter Training expires on 04/11/2025. Licensee’s pediatric CPR/First Aid certification expires on 04/15/2025.

LPA observed one infant in care during the inspection. LPA observed one crib for the infant in care, it is kept free from all loose articles and objects while infant is sleeping, and there are no objects hanging above or attached to the crib or play yard. License stated that infants are not swaddled while in care. Licensee physically checks 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 as they sleep in the daycare room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Per licensee Infants up to 12 months of age are placed on their backs for sleeping.

(Continued on 809-C.)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 09/07/2023

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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.

This facility does not provide Incidental Medical Services – IMS. 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. (Continued on 809-C.)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 09/07/2023

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Exit interview conducted and report was reviewed with Licensee Bertha Gomez. 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, there are no deficiencies.

Licensee Bertha Gomez 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 Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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