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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909484
Report Date: 08/20/2024
Date Signed: 08/21/2024 09:48:34 AM


Document Has Been Signed on 08/21/2024 09:48 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:VELASCO, MARIA ELENA FAMILY CHILD CAREFACILITY NUMBER:
503909484
ADMINISTRATOR:VELASCO, MARIA ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 324-5906
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 9DATE:
08/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Maria Elena VelascoTIME COMPLETED:
03:30 PM
NARRATIVE
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On 08/20/2024, Licensing Program Analysts (LPAs) Anita Tristan, Nohemi Sanchez and Xona Xayavong conducted an unannounced Case Management. LPAs met with Licensee; Maria Elena Velasco also present was licensee’s assistant. There were eight children present during today's inspection playing in front “day care room”. Licensee is Spanish Speaking and Nohemi Sanchez assisted with interpretation.

During today’s visit LPAs observed sleeping infant in stroller car seat combo in "master bedroom" with door closed. LPAs advised licensee to open the door and remove the sleeping infant (3) times and place infant in the crib. LPAs stayed in the room until licensee complied. LPAs informed licensee that per Title 22 regulations; car seats shall only be used for transportation purposes and shall not be used for sleeping. 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 and if an infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. LPAs reviewed infant safe sleep log for child #1 and found that the log had been falsified from 08/31/2024 through 10/27/2024 with licensee’s initials. LPAs went over safe sleep regulations with licensee. LPA informed licensee that as a result of falsifying documents licensee will receive a civil penalty of $500.00 for conduct inimical.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D)

Type A citations shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

A copy of this licensing report dated 08/20/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report and appeal rights were reviewed and discussed with Licensee, Maria Elena Velasco. Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
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


Document Has Been Signed on 08/21/2024 09:48 AM - 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: VELASCO, MARIA ELENA FAMILY CHILD CARE
FACILITY NUMBER: 503909484

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2024
Section Cited
CCR
102425(5)(A)

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(5) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
(A) The provider shall be able to visually observe the infant without moving the door.
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Licensee stated she will review the Infant Safe Sleep regulations and watch Safe Sleep videos on CDSS website.
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This requirement was not met by:
LPAs observed sleeping infant in stroller carseat combo in master bedroom with door closed. This poses a an immediate risk to the health and safety of the children in care
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Licensee will submit a written statement indicating how she will ensure that she follows safe sleep regulations for infants to CCL by POC due date 08/21/2024.

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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: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 08/21/2024 09:48 AM - 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: VELASCO, MARIA ELENA FAMILY CHILD CARE
FACILITY NUMBER: 503909484

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2024
Section Cited
HSC
1596.885(c)

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Health and Safety Code Section 1596.885(c): Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.
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LPA went over safe sleep log with licensee. Licensee stated that she will redo safe sleep log and not pre-fill dates and initial. Licensee will provde copy of new sleep log by POC date 08/21/2024.
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This requirement was not met by:
Licensee falsifying Infant safe sleep log from 08/31/2024 through 10/27/2024 with licensee's initials. This poses an immediate risk to the health, safety, and personal rights of children in care.
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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: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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