<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503608503
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:14:01 AM


Document Has Been Signed on 09/05/2023 11:14 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:BERMUDEZ, SALLYFACILITY NUMBER:
503608503
ADMINISTRATOR:BERMUDEZ, SALLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 538-1041
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:14CENSUS: 4DATE:
09/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sally BermudezTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 5, 2023, Licensing Program Analyst (LPA), Miguel Herrera conducted an unannounced Annual Required Inspection and was met by Licensee Sally Bermudez. Days and hours of operation are Monday through Friday, 7:00AM through 5:30PM. The home has working telephone service and LPA confirmed the phone number is 209-538-1041.

LPA toured the home inside and outside and a census was taken. LPA Herrera conducted a census and there are 4 children in the home with Licensee. 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. LPAs reviewed current facility sketch and confirmed that the living room, family room, dining room, kitchen, and bathroom (1) are used for providing care and are accessible to children. This is a two-story home and stairs are gated when children under age 5 years old are present. The stairs are located at the entryway of the home.

All firearms and ammunition are stored and locked separately in a gun safe located in the upstairs master bedroom. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is one fireplace in the home located in the living room and is made inaccessible by a screen and will not be in use during daycare hours. There is a working fire extinguisher located in the kitchen. The smoke detector and carbon monoxide detector are in working conditions. 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.

During the inspection, LPAs observed safe toys and play equipment in the family room. LPA did not observe any hazardous items in the kitchen. The bathroom used by daycare children was observed to be free from hazards.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel HerreraTELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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 3


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: BERMUDEZ, SALLY
FACILITY NUMBER: 503608503
VISIT DATE: 09/05/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The outdoor play area in the backyard is fenced. There is a built-in ground swimming pool in the backyard which is fenced and made inaccessible. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area.

LPA advised for licensee to conduct frequent safety inspections around the pool area and continue to maintain the pool fence as wear and tear can damage the pool fence. Licensee is aware of child safety around the pool area 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 reviewed a sample of children’s files and observed all files to be complete with the immunizations and required documents.


Licensee’s Mandated Reporter Training expires on 02/27/2025. Licensee’s pediatric CPR/First Aid certification expires on 04/2024. A review of records indicates that licensee has immunization records on file for influenza, pertussis and measles.

There is 1 infant present during today’s inspection. LPA discussed Safe Sleep Regulations with licensee. There is one play yard for the infant in care located in the living room. 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 crib or play yard. Infant is not swaddled while in care. Provider physically checks on sleeping infant every fifteen minutes documenting sleep for any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. LPA discussed the regulation surrounding the Sleep Plan. Infant can be visually observed through an open door if sleeping in a separate room. Licensee understands that infants up to 12 months of age are to be placed on their backs for sleeping.

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.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel HerreraTELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BERMUDEZ, SALLY
FACILITY NUMBER: 503608503
VISIT DATE: 09/05/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

Exit interview conducted and report was reviewed with Licensee Sally Bermudez. 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 Sally Bermudez 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: Miguel HerreraTELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3