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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103809921
Report Date: 06/09/2022
Date Signed: 06/30/2022 11:18:23 AM

Document Has Been Signed on 06/30/2022 11:18 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
FRESNO-CC, 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:
06/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Martha AragonTIME COMPLETED:
09:30 AM
NARRATIVE
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On 6/9/22 Licensing Program Analyst (LPA) Caroline Harris attempted to conduct an annual inspection, and was greeted by licensee, Martha Aragon. Upon arrival, the LPA was informed that the licensee had an outbreak of influenza in her home day care, that also effected her family. The outbreak was not reported to the Fresno CCL office. The licensee was currently caring for children, that no longer had symptoms of a fever but were still showing other symptoms. Due to some symptoms still being present, the LPA did not enter the licensee's home. The LPA went over reporting requirements with the licensee.

On 6/10/22 LPA attempted to contact the licensee in order to conducted an exit interview with Martha Aragon via telephone. There was no answer and the LPA left a voice message. On 6/16/22 and again on 6/30/22, the LPA tried contacting the licensee. There was no answer and the LPA was unable to leave a voice message either of the times.

California Code of Regulations, Title 22, Division 12, Chapter (3), are being cited on the attached LIC 9099D.

On 6/30/22, a printed copy of this report as well as appeal rights were mailed to the licensee, Mrs. Aragon along with a notice of site visit. A Notice of Site Visit is to be posted for 30 days. Mrs. Aragon was asked to sign the report and send a copy back to the Fresno CCL office.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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 06/30/2022 11:18 AM - It Cannot Be Edited


Created By: Caroline Harris On 06/10/2022 at 01:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ARAGON, MARTHA FAMILY CARE HOME
FACILITY NUMBER: 103809921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
102416.2(b)

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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A)
through (b)(1)(C) that occur during the operation of the family child care home.
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The licensee agrees to review the reporting requirements training on the CCL website and submit a statement of what those requirements are, along with an Unusual Incident Report to the Fresno CCL office no later than 7/8/22.
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This requirement was not met as evidenced by the licensee having an outbreak of influenza in her home day care, that she did not report to CCL. This is a possible risk to the health, safety or personal rights of 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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022


LIC809 (FAS) - (06/04)
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