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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543908752
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:29:53 PM


Document Has Been Signed on 10/04/2022 02:29 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:HERNANDEZ, GLORIA FAMILY CHILD CAREFACILITY NUMBER:
543908752
ADMINISTRATOR:HERNANDEZ, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 310-9969
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 5DATE:
10/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Gloria HernandezTIME COMPLETED:
02:50 PM
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On 10/4/2022, Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced Annual Required Inspection and was met by Licensee, Gloria Hernandez. Also present was Staff #2 (S2). Licensee is Spanish Speaking and LPA Ocegueda assisted with interpretation. Days and hours of operation are Monday through Friday 5:30 AM 6:00 PM and other hours as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen, living room, family room and one bathroom are accessible to children. The children remain mostly in the family room. All other rooms are off-limits and made inaccessible by use of baby gates and door knobs safety covers. Swimming pool is fenced per regulation. 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. There are no firearms or ammunition on the premises. Detergents, cleaning compounds (Lysol spray, Clorox cleaning products, glass cleaner, Easy off brand cleaner) were observed under the accessible kitchen sink today. The kitchen sink had two safety latches, but one latch was broken. On top of the kitchen counter there was a bottle of bleach that had a child safety cap. In an accessible kitchen drawer, there were multiple knives. In the accessible bathroom, licensee had toothpaste and sunscreen in an accessible drawer. There was also a person who was completing floor work in the living room, away from the children and not providing care and supervision. The worker had power tools he was using to cut the wood flooring. The children were being cared for in the separate family room with a door that was shut, but unlocked and there was no door knob safety cover. Today the baby gate that is usually in place between the kitchen and living room was not in place. Currently the children were entering through the garage. There was no record of licensee contacting the Department to report this or inquire about the change in how the children would enter her home during the floor work being completed in her home. Report continued to 809-C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
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 8


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ, GLORIA FAMILY CHILD CARE
FACILITY NUMBER: 543908752
VISIT DATE: 10/04/2022
NARRATIVE
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There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 310-9969.

LPA discussed Safe Sleep Regulations with licensee. Today, there was an infant who was under 12 months old (child #2) who did not have a crib or play pen. LPA also observed that an infant under age 2 (child #4) was sleeping inside a highchair. Licensee did not have LIC 9227 (Individual Infant Sleep Plan) for child #2 and did not have required 15 minute nap log for either infant in care. LPA discussed safe sleep regulations with licensee and provided her with written and online resources.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files. LPA observed that children #2, #3, #5 did not have required Consent for Medical Treatment (LIC 627). Licensee’s Mandated Reporter Training was completed on 7/16/2022. Licensee’s pediatric CPR/First Aid expires on 2/17/2023. A review of records for staff was completed. Licensee and S2 had proof of Pertussis and a flu declination statement, however were missing proof of Measles vaccine.

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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ, GLORIA FAMILY CHILD CARE
FACILITY NUMBER: 543908752
VISIT DATE: 10/04/2022
NARRATIVE
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LPA and Licensee 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies being cited: (see next page, 809 D) Licensee was provided a copy of 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 8 of 8
Document Has Been Signed on 10/04/2022 02:29 PM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: HERNANDEZ, GLORIA FAMILY CHILD CARE
FACILITY NUMBER: 543908752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed several cleaning products (Lysol, Clorox brand ect) under an accessible kitchen sink. On a kitchen counter, there was bleach. In an accessible bathroom drawer, there was toothpaste and sunscreen. The children also had access to power tools as the door in the living room the children were using was not locked or had child safety cover and the child gate that is typically in place was down today due to floor installation that was taking place. This a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2022
Plan of Correction
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Licensee stated that the floor installation would be completed today. Today, Licensee placed the baby gate back up making the power tools inaccessible. Today, Licensee placed a functioning safety device on the kitchen sink and removed the bleach. Licensee placed the kitchen knives on top of the refrigerator. Licensee removed the toothpaste and the sunscreen from the kitchen bathroom and made it inaccessible. Deficiency cleared today.
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Today, LPA did not observe a play yard or crib for infant #2 and licensee indicated that she did not have a play yard or crib for infant #2. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2022
Plan of Correction
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Licensee stated she would obtain a proper crib or play yard for infant #2 and understands that infants under 12 months old should only sleep in a crib or a play pen so long as they cannot climb out. A return inspection will be made to verify that the deficiency stated above is corrected.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8


Document Has Been Signed on 10/04/2022 02:29 PM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: HERNANDEZ, GLORIA FAMILY CHILD CARE
FACILITY NUMBER: 543908752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. An infant over the age of 12 months was observed sleeping in a high chair. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2022
Plan of Correction
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Licensee removed the infant out of the highchair today and placed her on a sleeping mat. Licensee will obtain safe sleep training via the following website: safetosleep.nichd.nih.gov. Licensee stated she will print out the transcripts of each of the four videos and sign and date them. A return inspection will be conducted to verify the deficiency was corrected.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Child #2, #3, and child #5 did not have Emergency Medical Consent form (LIC 627). This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2022
Plan of Correction
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Licensee stated she would have the parents complete this form for the children (#2, #3, #5) and place in their files. A return inspection will be conducted to verify the deficiency was corrected.

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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 8