503909242-8-3-2022-04-CC-DLEN-CH4UD2-20220808152845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 503909242
Report Date: 07/22/2022
Date Signed: 08/03/2022 01:14:38 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2022 and conducted by Evaluator Stefanie Galvan

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20220526113022

FACILITY NAME:	BELERIQUE, NANCY FAMILY CHILD CARE		FACILITY NUMBER:	503909242
ADMINISTRATOR:	BELERIQUE, NANCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 480-7370
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	14	CENSUS:	DATE:	07/22/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee, Nancy Belerique		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility operating over license capacity

INVESTIGATION FINDINGS:

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An unannounced complaint visit was conducted today by LPA Stefanie Galvan. LPA met with Licensee, Nancy Belerique. LPA toured the facility and a census was taken. The purpose of today’s visit is to close the above complaint investigation. The investigation revealed the following: During visit licensee stated, "I had to have more kids sometimes, I didn't have any helpers."
Based upon information obtained and interviews conducted, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
California Code of Regulations, Title 22, Division 12, Chapter 3, are being cited on the attached LIC 9099D.

Exit interview conducted with licensee. A copy of this report and appeal rights were provided. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days. The licensee shall post and provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of this report must be given to each enrolled child's parent(s). The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. The licensee must implement the new procedure immediately, by having all parents of enrolled children sign the Acknowledgement of Receipt of Licensing Reports and must retain a copy in each child's file.

Substantiated

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Stefanie Galvan	TELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 04-CC-20220526113022

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BELERIQUE, NANCY FAMILY CHILD CARE	FACILITY NUMBER: 503909242
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/29/2022 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	Staff Ratio & Capacity (a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.This requirement was not met as evidenced by: LPA findings during investigation of complaint. This poses an immediate risk to the health, safety, and personal rights of children in care.	1 2 3 4 5 6 7	Licensee to write a statement as to how she will plan to maintain license limit for children in care at all times. Licensee will send a letter to parents acknowledging that she will not be able to provide care for their children once her capacity has been met. Plan of correction to be submitted to CCL office by 7/29/22.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Stefanie Galvan	TELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC9099 (FAS) - (06/04)

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