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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503810019
Report Date: 10/04/2023
Date Signed: 10/04/2023 11:46:14 AM


Document Has Been Signed on 10/04/2023 11:46 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:CCCSC, INC. - AUDREY'S HOUSEFACILITY NUMBER:
503810019
ADMINISTRATOR:GARCIA, COLLEENFACILITY TYPE:
830
ADDRESS:141 KIMBLE STTELEPHONE:
(209) 577-0138
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY:12CENSUS: 9DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Heidi OrtegaTIME COMPLETED:
12:00 PM
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On 10/4/2023 Licensing Program Analyst (LPA), Yesenia Fierro conducted an unannounced Annual Required Inspection for the infant license. LPA met with Site Supervisor, Heidi Ortega, and toured the facility indoors and outdoors. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were 9 day care children present. This facility a full day program Monday through Friday from 8:00 AM- 6:00 PM.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Floors in the facility are clean and safe. There is adequate heating and ventilation for safety and comfort. All materials and surfaces accessible to children are toxic free. The facility has a complete first aid kit. All toilets, changing tables and handwashing facilities are in safe and sanitary operating condition. Menus are posted at least one week in advance where an authorized representative can view them. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) degrees or less. Drinking water is available both indoors and outdoors.



Solid waste storage containers have tight-fitting covers and are in good repair. The facility is free of flies, insects, and rodents. The LPA did not observe disinfectants, cleaning solutions and other dangerous items to be accessible to children. No poisons were observed during the inspection. Licensee is aware that poisons are required to be locked and inaccessible to children.

Infant changing tables have a padded surface and are covered with washable vinyl or plastic and have raised sides at least three inches high. Toys observed are safe with no sharp points, edges or splinters and are without small parts that can be pulled off and swallowed. The facility has sufficient cribs, cots, or mats for infant napping. There is indoor and outdoor activity space for infants that is physically separate. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls.
CON'T 809-C
SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CCCSC, INC. - AUDREY'S HOUSE
FACILITY NUMBER: 503810019
VISIT DATE: 10/04/2023
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Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff 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. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. Capacity and limitations as specified on the license are being maintained.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, immunizations recorded, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements. Staff are fingerprint cleared through the facility main license which is Childrens Crisis Center of Stanislaus County 500308670.

There is no swimming pool or other bodies of water on the premises. Firearms/weapons or ammunition are not allowed or stored on the premises. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, that meet statutory requirements. This facility does have one person trained in CPR and first aid.


Incidental Medical Services (IMS) are not currently being provided. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm
CON'T 809-C
SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CCCSC, INC. - AUDREY'S HOUSE
FACILITY NUMBER: 503810019
VISIT DATE: 10/04/2023
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Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice.

Facility did not complete lead testing as building was rebuilt from the ground up in 2017. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for


drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Site Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA and Site Supervisor 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.

LPA discussed the safe sleep regulations with Site Supervisor 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 Site Supervisor 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 infants’ devices with the CPSC to be notified of any recalls on their purchased equipment. CON'T 809-C

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CCCSC, INC. - AUDREY'S HOUSE
FACILITY NUMBER: 503810019
VISIT DATE: 10/04/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor Heidi Ortega.

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
LIC809 (FAS) - (06/04)
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