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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910684
Report Date: 12/21/2023
Date Signed: 12/21/2023 09:55:34 AM

Document Has Been Signed on 12/21/2023 09:55 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:WENCE DE VACA, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 231-7414
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Ana Wence De VacaTIME COMPLETED:
10:15 AM
NARRATIVE
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On 12/21/2023, Licensing Program Analysts (LPAs) Pa Kou Vue and Monica Lopez conducted an unannounced case management inspection following a required 3-year annual inspection conducted on 12/13/2023. LPAs were met by Licensee Ana Wence De Vaca who accompanied LPAs during a tour of facility both inside and outside and a census was taken. Licensee is Spanish speaking. LPA Monica provided translation. LPAs explained the purpose for the inspection.

On 12/13/2023, LPA Pa Kou experienced technical difficulties with FAS. FAS auto-generated two separate

“LIC 809 – FER – Visit date 12/13/2023 Visit Type REQUIRED – 3 YEAR.” On today’s visit, the second generated LIC 809 was rectified along with the attached LIC forms reattached onto the LIC809 Case Management report. LPAs obtained LIC 9102’s Technical Violations, LIC 809-D pages and LIC421IM from 12/13/2023 and provided Licensee with copies of today’s final recorded LIC 809 report, LIC 9102’s Technical Violations, LIC 809-D pages and LIC421IM from 12/13/2023.

During today’s inspection, LPAs reviewed LIC 999A Facility Sketch with Licensee and confirmed that the backyard is not accessible to children. LPA updated Licensee’s facility sketch. Licensee initialed and date facility sketch.

LPAs discussed Child Care Licensing’s (CCL) regulations regarding bodies of water. LPAs provided Licensee with a copy of CCR102417(5)(A). In addition, Licensee was reminded that even though the backyard is marked off-limits, Licensee is still required to follow CCL regulations by always making the pool and jacuzzi inaccessible to day-care children. Licensee stated she understood.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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 12/21/2023 09:55 AM - It Cannot Be Edited


Created By: Pa Kou Vue On 12/21/2023 at 09:14 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: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/14/2023
Section Cited
CCR
102417(g)(5)

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(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.
This requirement is not met as evidenced by:
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Licensee stated she will place pool covering back on once husband arrives home. Licensee stated she will submit pictures to LPA via email by end of work day 12/14/2023 for verification.
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Based on LPAs observations, there is an in-ground pool and jacuzzi located in accessible backyard with NO fence or pool covering. Licensee stated the pool covering was removed by husband yesterday. The licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons 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:Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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Document Has Been Signed on 12/21/2023 09:55 AM - It Cannot Be Edited


Created By: Pa Kou Vue On 12/21/2023 at 09:20 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: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
102417(g)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:
This requirement is not met as evidenced by:
LPA observed in accessible kitchen 2 drawers with multiple butter knives, metal kebab skewers, metal meat pounder,
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Licensee stated she will reinstall safety latches for the drawers and cabinet underneath the kitchen sink to make them inaccessible to daycare children. Licensee stated she will submit pictures to LPA via email by enf of working day 12/15/2023.
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vegetable and fruit peeler and wine cork screws. Underneath kitchen sink were disinfecting wipes, Febreze air kitchen odor and Great Value disinfectant spray underneath kitchen sink with NO safety latches. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/15/2023
Section Cited
CCR102416.1(a)

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(a) Personnel records shall be maintained on each employee and shall contain the following information:
This requirement is not met as evidenced by:
Based on LPA records review and Licensee interview, Licensee does not have Mandated Reporter Training and TB.
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Licensee stated she will submit the requested documents to LPA via email by end of working day 12/15/2023.
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Assistant does not have LIC9052, LIC508 and a copy of Assistant's driver's license. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons 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:Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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Document Has Been Signed on 12/21/2023 09:55 AM - It Cannot Be Edited


Created By: Pa Kou Vue On 12/21/2023 at 09:27 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: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
102421(a)

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(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement is not met as evidenced by:
Based on LPA records review and Licensee interview, child #1 does not have LIC627, ID, 15-minute sleep logs and LIC9227, child #2 does not have LIC9227 and 15-minute sleep logs,
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Licensee stated she will submit copies of the requested documents to LPA via email by end of working day 12/15/2023. LPA informed Licensee LIC forms may be accessed via the CDSS website. In addition, Licensee was provided updated 15 minute sleep log checks.
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child #3 does not have LIC613A, LIC627, LIC995A and LIC282, child #4 does not have LIC700, LIC627, LIC9150 and LIC995A, child #5 does not have LIC613, LIC9227, 15-minute sleep logs and Immunization Records and child #6 does not have LIC627. the licensee did not comply with the section cited above in out of which poses/posed a potential health, safety or personal rights risk to persons 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:Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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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: 12/21/2023
NARRATIVE
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Exit interview conducted and report was reviewed with Licensee. During the exit interview, the Licensee stated 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, no deficiencies are cited.

Licensee was provided appeal rights. LPAs informed Licensee appeals must be submitted to CCL within 15 business days from the date of the inspection. Licensee stated she understood.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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