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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911244
Report Date: 02/16/2022
Date Signed: 02/16/2022 04:41:24 PM


Document Has Been Signed on 02/16/2022 04:41 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MADRIGAL, MARGARITA FAMILY CHILD CAREFACILITY NUMBER:
543911244
ADMINISTRATOR:MADRIGAL, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 623-9282
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:14CENSUS: 10DATE:
02/16/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Margarita MadrigalTIME COMPLETED:
05:00 PM
NARRATIVE
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On 2/16/2021, Licensing Program Analyst (LPA) Theresa Marquez conducted a routine inspection and met with Licensee Margarita Madrigal.

During this inspection, LPA Marquez observed 10 children present. 5 of the children were infants, 1 child was over the age of 2 years and 2 school age children that were licensee's own children.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiency was found: See attached LIC809-D:

An exit interview was conducted and report was reviewed with the Margarita Madrigal. A copy of Appeal Rights and the Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2022
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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Document Has Been Signed on 02/16/2022 04:41 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MADRIGAL, MARGARITA FAMILY CHILD CARE
FACILITY NUMBER: 543911244

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2022
Section Cited

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STAFFING RATIO AND CAPACITY - For a Large FCCH, the max number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
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Twelve children, no more than four of whom may be infants. This requirement was not met as evidenced by LPA observation. On 2/16/2022, LPA Marquez observed 10 children, 5 of whom are infants. This poses a potential risk to the health, safety and personal rights to 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2022
LIC809 (FAS) - (06/04)
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