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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910684
Report Date: 12/05/2024
Date Signed: 12/05/2024 11:23:35 AM

Document Has Been Signed on 12/05/2024 11:23 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WENCE DE VACA, ANA FAMILY CHILD CAREFACILITY NUMBER:
103910684
ADMINISTRATOR/
DIRECTOR:
WENCE DE VACA, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 231-7414
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ana Wence De VacaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 12/05/2024 Licensing Program Analyst (LPA), Brandon Tate conducted an unannounced Annual Random Inspection and was met by licensee Ana Wence De Vaca. Also present was licensee’s assistant Adriana Reyes Wence. Licensee’s assistant has background clearance and all proper documentation to perform assistant duties within the licensed facility. Days and hours of operation are Monday through Friday from 0700 to 1730 hours.

LPA toured the home inside and outside and a census was taken of 3 children present during today’s inspection. LPA reviewed current facility sketch and confirmed that the kitchen, bathroom, and daycare room are used for providing care and are accessible to children in care. All other rooms are off-limits and made inaccessible by use of a baby gate at the stairs and doorknob spinners on all other exits from the area.

There is a built-in swimming pool in the backyard which is fenced and made inaccessible. Upon inspection of the backyard area containing the fenced built-in swimming pool, LPA Tate observed that the pool gate is not self-latching, or self-closing which poses an immediate threat to the health and safety of children in care. This will be a Type-A deficiency today. The gate does open away from the swimming pool. No windows or doors have direct access to the pool area.

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 one fireplace in the home located in the living room and is made inaccessible by a metal screen and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. This is a two-story home, and stairs are gated when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 231-7414.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Capacity as specified on the license is being maintained.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Brandon Tate
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/05/2024 11:23 AM - It Cannot Be Edited


Created By: Brandon Tate On 12/05/2024 at 09:58 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: WENCE DE VACA, ANA FAMILY CHILD CARE

FACILITY NUMBER: 103910684

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to the pool gate not self-closing which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2024
Plan of Correction
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The licensee stated that her husband will return from work on 12/06/2024 and will repair the fence immediately so the pool gate will self-latch. Licensee stated she will send video proof via email or text to LPA Tate.

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:Brandon Tate
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


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Document Has Been Signed on 12/05/2024 11:23 AM - It Cannot Be Edited


Created By: Brandon Tate On 12/05/2024 at 10:46 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: WENCE DE VACA, ANA FAMILY CHILD CARE

FACILITY NUMBER: 103910684

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which both the licensee and the assistant had expired CPR/FirstAid certification which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/02/2025
Plan of Correction
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Licesee stated that she will schedule a class for herself and her assistant. Licensee stated she will send a picture via email or text to LPA Tate of the completion certificate.
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:Brandon Tate
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


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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: WENCE DE VACA, ANA FAMILY CHILD CARE
FACILITY NUMBER: 103910684
VISIT DATE: 12/05/2024
NARRATIVE
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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 12/15/2023. Licensee’s pediatric CPR/First Aid certification expired on 03/04/2024 which poses a potential threat to the health and safety of children in care. This will be a Type-B deficiency today. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

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.

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.

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.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Brandon Tate
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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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: WENCE DE VACA, ANA FAMILY CHILD CARE
FACILITY NUMBER: 103910684
VISIT DATE: 12/05/2024
NARRATIVE
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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 Ana Wence De Vaca. 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, of the California Code of Regulations, the following deficiencies are being cited: (see next page). Licensee was provided appeal rights.

LPA Tate informed licensee Ana Wence De Vaca that this report dated 12/05/2024 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA Tate informed the licensee to provide a copy of this licensing report dated 12/05/2024 that documents the Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee.

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: Brandon Tate
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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