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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808931
Report Date: 11/30/2022
Date Signed: 12/01/2022 09:28:45 AM

Document Has Been Signed on 12/01/2022 09:28 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KIDZ CAN 2FACILITY NUMBER:
103808931
ADMINISTRATOR:ALEJANDREZ, NANCYFACILITY TYPE:
850
ADDRESS:130 NORTH U STREETTELEPHONE:
(559) 492-2907
CITY:FRESNOSTATE: CAZIP CODE:
93701
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 14DATE:
11/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Nancy AlejandrezTIME COMPLETED:
03:00 PM
NARRATIVE
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On 11/30/2022, Licensing Program Analysts (LPAs) Ka Vang and Cynthia Brannon conducted an unannounced case management inspection. LPAs were met by Licensee Nancy Alejandrez and Office Manager Alyssa Ybarra. LPAs toured the facility, and a census was taken. The purpose of today's inspection was to follow-up with the deficiency that was cited on 10/07/2022 as the facility did not have a qualified site director.

During today’s inspection, LPA explained to Alyssa Ybarra that on 11/29/2022, LPA Ka reviewed the director packet for Sandra Rivera and the following forms and information were received and reviewed:

LIC 501 Personnel Record


LIC 503 Health Screening Report
LIC 508 Criminal Record Statement
LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
LIC 9182 Original background clearance transfer request
LIC 500 Personnel Report
LIC 610 Emergency Disaster Plan
LIC 308 Designation of Facility Responsibility
LIC 309 Administrative Organization.
LIC 9052 Employee Rights.
Transcript from Fresno City College. ** Missing the three (3) units in Administration/Staff Relations
Letter of verification that Sandra has work experiences in Early Childhood Education (ECE) for more than 2 years.
EMSA Certified First Aid CPR and Health and Safety course completion certification.
Proof of TB, Whooping Cough, Measles, and influenza (declination statement opting out of flu shot)
Proof of center Orientation completion – Component II – Operations and Record Keeping.

(Continued on LIC809-C).
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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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: KIDZ CAN 2
FACILITY NUMBER: 103808931
VISIT DATE: 11/30/2022
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LPA reviewed with Office Manager Alyssa that the director packet had all the above mentioned forms and information but Sandra River did not have the three (3) units in Administration/Staff Relations. Alyssa requested an exception for Sandra River as she is enrolled in the Administration/Staff relations class at Reedley College starting 01/09/2023 to 03/10/2023.

During today's inspection, Licensee submitted the exception letter and pending for Sandra to print her class enrollment schedule to submit to LPA for review.

Per the California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency is been cited during today’s inspection. Facility Representative Alyssa Ybarra was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Nancy Alejandrez and Office Manager Alyssa Ybarra.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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