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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543903669
Report Date: 04/11/2023
Date Signed: 04/11/2023 02:23:32 PM

Document Has Been Signed on 04/11/2023 02:23 PM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ORTIZ, DEBORAH FAMILY CHILD CAREFACILITY NUMBER:
543903669
ADMINISTRATOR:ORTIZ, DEBORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 920-0860
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Deborah OrtizTIME COMPLETED:
02:35 PM
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On 4/11/2023, Licensing Program Analyst (LPA) Ocegueda observed an Unusual Incident while conducting a required annual inspection at the facility. LPA toured the home and took a census. LPA met with licensee Deborah Ortiz.

During the inspection of the play yard, child #1 suddenly ran back inside and locked the door. LPA and licensee were about done inspecting the back yard, when LPA and licensee observed that the door was locked. Licensee yelled out to the child to unlock the door and went around to the front yard to try and see if the front door was open. There were no unlocked doors. After not being able to convince the child to unlock the door, licensee sought help from her neighbor across the street. During that process, child unlocked the door and LPA and licensee were able to gain entry. Child was locked in the home for approximately 5 minutes. Licensee stated that this had never happened before.

Today, LPA and licensee discussed supervision and provisions to be taken after this incident. Licensee indicated that child #1 is active and has a history of behavioral difficulties at times. Licensee has a sound alarm on each door and keeps the doors locked. Licensee will be providing her trusted neighbor with a key in case of an emergency. Licensee will be meeting with and reporting this incident to the parents of child #1 to help ensure child understands behavioral expectations. Licensee will ensure supervision of children while outside and will not allow children to walk inside the home alone for any reason.

This incident was reviewed with licensee and LPA and licensee discussed LIC 624 (Unusual Incident Report) that licensee understands must be submitted to the Department within 7 days.

LPA determined that this was an isolated incident and not a result of lack of care and supervision

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, no deficiencies are cited today. LIC 9213 Notice of Site Visit will be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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