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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910599
Report Date: 03/04/2025
Date Signed: 03/04/2025 12:23:51 PM

Document Has Been Signed on 03/04/2025 12:23 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MEDINA, CLAUDIA FAMILY CHILD CAREFACILITY NUMBER:
103910599
ADMINISTRATOR/
DIRECTOR:		MEDINA, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 853-8822
CITY:FRESNOSTATE: CAZIP CODE:
93728
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
03/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:32 AM
MET WITH:Claudia MedinaTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
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On September 25, 2023, Licensing Program Analyst (LPA), Miguel Herrera conducted an unannounced Annual Required Inspection and was met by Licensee Claudia Medina. Days and hours of operation are Monday through Friday, 6:00AM through 5:30PM. The home has working telephone service and LPA confirmed the phone number is 559-853-8822.

LPA toured the home inside and outside and a census was taken. LPA Herrera conducted a census and there is 5 children in the home during today’s visit. Capacity as specified on the license is being maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. LPA reviewed current facility sketch and confirmed that the living room, bathroom, kitchen, dining room, room #1 and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by locked doors. This is a two-story home; the second story of the home is inaccessible to children by a locked door.

The fireplace located in the living room is secured with a screen inaccessible to daycare children. There is no swimming pool in the premise, however there is a small in ground water fountain/pond in the front yard is filled with rocks to prevent water from accumulating. LPA Herrera discussed and reviewed "bodies of water" with Licensee Medina and she stated that she understood.

Per licensee there are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a working fire extinguisher located in the laundry room. The smoke detector and carbon monoxide detector are in working conditions and are located in the hallway. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality. There is adequate heating and ventilation for safety and comfort of the children. LPA observed the most current fire drill documentation with the date, time and how many children present. LPA Herrera reminded Licensee Medina to conduct the fire drills at least once every 6 months. Licensee has a current roster of the children. To be continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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 03/04/2025 12:23 PM - It Cannot Be Edited


Created By: Miguel Herrera On 03/04/2025 at 11:19 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: MEDINA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 103910599

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During records review LPA Herrera did not observe immunization records for child #5 and incomplete records for child #3, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2025
Plan of Correction
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Licensee stated that she will ensure to obtain and submit records for child #5 and updated records for child #3 to CCLD via text/email by POC deadline.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During file review LPA Herrera did not observe an "Individual Sleeping Plan" (LIC 9227) on file for child #5, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2025
Plan of Correction
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Licensee stated that she will ensure to complete the LIC 9227 with child #5's parents and submit a copy of the LIC 9227 form to CCLD via text/email by POC deadline.
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:Miguel Herrera
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/04/2025 12:23 PM - It Cannot Be Edited


Created By: Miguel Herrera On 03/04/2025 at 11:19 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: MEDINA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 103910599

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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During records review LPA Herrera did not observe a 15 sleep minute log for child #5, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2025
Plan of Correction
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Licensee stated that she will ensure to documenet the 15 minute sleep log and submit a copy of the log to CCLD Fresno by 03/18/2025, via text/email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Miguel Herrera
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MEDINA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 103910599
VISIT DATE: 03/04/2025
NARRATIVE
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During the inspection, LPA observed safe toys and play equipment in the room designated for childcare. LPA did not observe any hazardous items in the kitchen. The bathrooms used by children were observed to be free from hazards. Per Licensee, she has one dog in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. The outdoor play area in the backyard is fenced.

LPA reviewed a sample of children’s files and observed that child #3 had incomplete immunization records on file and child #5 was missing required immunization records. The sample files had all other licensing required records on file. Licensee has a current Mandated Reporter Training and a current CPR/First Aid certification. A review of records indicates that licensee has immunization records on file for influenza, pertussis, and measles.



Licensee has 1 infant enrolled in the facility. Licensee understands that infants in the facility, shall have one play yard/crib for each infant in care. Per licensee, the play yard/crib is kept free from all loose articles and objects while the infant is sleeping, and there are no objects hanging above or attached to the play yard. Per licensee, infants are not swaddled while in care. Licensee stated that she monitors and observes the infant while they sleep. However, licensee was unable to produce the infant's 15 minute sleep logs that document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Per licensee the infant can be visually observed through an open door if sleeping in a separate room. Licensee was unable to produce the infant's "Safe Sleep Plan" (LIC 9227) that documents if the infant can roll over while they sleep. Licensee stated that she ensures that the infant is laid in their back when they are put down to sleep.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To be continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MEDINA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 103910599
VISIT DATE: 03/04/2025
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LPA discussed safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility does not provide Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Licensee Claudia Medina. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited during today’s visit (see 809-D). Licensee Claudia Medina was provided appeal rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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