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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103809921
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:53:13 PM

Document Has Been Signed on 08/02/2022 12:53 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-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: 5DATE:
08/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Martha AragonTIME COMPLETED:
01:20 PM
NARRATIVE
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On 8/2/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with licensee, Martha Aragon and her assistant and toured the home. A census was taken and there were five children.

The purpose of the inspection is to clear deficiencies that were previously cited on 7/12/22. LPA reviewed children's files and observed that copies of immunization records were still missing in most of the children's files. Children's files were also not complete with required licensing documents. LPA reviewed staff files and did observe the licensee and one assistant to have proof of MMR and T-Dap but the assistant present did not have proof of immunizations or other required licensing forms or documents. Upon inspection of the home, the LPA observed the licensee to have placed latches on cabinets and drawers in the kitchen that hold keep out of reach items in them, but the licensee did not have all of the latches secured. Off limits rooms were closed and had door spinners on them. Infant 15 minute checks are being completed and logged. The licensee also had purchased tight fitted sheets for the infant pack and plays. During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page): 809 D An exit interview was conducted and a copy of this report (along with appeal rights) was provided to the licensee, Martha Aragon and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice of Site Visit form was provided to the licensee and must remain posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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 08/02/2022 12:53 PM - It Cannot Be Edited


Created By: Caroline Harris On 08/02/2022 at 11:48 AM
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: 08/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2022
Section Cited
CCR
102416.1(d)

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All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement was not met as evidenced by the licensee not maintaining complete staff records
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The LPA previously mailed copies to the licensee of what was available in the Fresno CCL file. The licensee understands that files must be maintained at the home and agrees to have staff complete required forms and get
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at the home. This is a possible risk to the health, safety or personal rights of children in care.
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required documents. The LPA reviewed with the licensee, a list that was previously given to her, of what information is required to be in each assistants files. A return visit will take place to clear this deficiency.

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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: 08/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022


LIC809 (FAS) - (06/04)
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