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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103809921
Report Date: 06/28/2021
Date Signed: 06/28/2021 11:48:03 AM

Document Has Been Signed on 06/28/2021 11:48 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ARAGON, MARTHA FAMILY CARE HOMEFACILITY NUMBER:
103809921
ADMINISTRATOR:ARAGON, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 801-1153
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Martha AragonTIME COMPLETED:
12:00 PM
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On 6/28/2021, Licensing Program Analysts (LPAs) Theresa Marquez and Kari McWilliams conducted an unannounced annual inspection and met with Licensee, Martha Aragon. Assistant Cassie Aragon was also present. A tour of the home was conducted, and a census was taken. Business hours are Monday through Friday 6:00 AM to 6:00 PM and other hours as arranged.
Current facility sketch reviewed, and Licensee confirmed the family room and the bathroom off the laundry room are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of spinner knobs. The fireplace located in the family room was made inaccessible to children by a glass screened door and will not be used during day care hours. Cooling and ventilation was sufficient for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified.

LPA did not observe any poisons in the home. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort.
The outdoor play area in the backyard is fenced. Licensee ensures that children in care are supervised at all times. There was an empty kiddie swimming pool. Licensee confirmed that the swimming pool is empty after each use. No firearms were on the premises.

There are currently no infants in care. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children. LPA discussed Safe Sleep Regulations with Licensee.

Adequate supervision was being provided during this inspection and capacity as specified on the license was being maintained.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2021
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: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921
VISIT DATE: 06/28/2021
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A sample of children’s records were reviewed. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance. Licensee could not provide proof of the required immunizations or a written declaration declining the flu shot for herself and her assistant. Licensee has not completed the required Mandated Reporter Training. LPA discussed required Mandated Reporter Training to be completed by July 6, 2021. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee's pediatric CPR and First Aid expires on 7/18/2021.

Incidental Medical Services (IMS) are not currently 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. http://www.ada.gov/childqanda.htm

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 no deficiencies were observed today.

Licensee is to update the Emergency Disaster Form LIC610a and the Facility sketch LIC999. These licensing forms shall be submitted by July 2, 2021.

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
LIC809 (FAS) - (06/04)
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