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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911169
Report Date: 12/01/2023
Date Signed: 12/01/2023 12:05:37 PM

Document Has Been Signed on 12/01/2023 12:05 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:WILBORN, PATRICE FAMILY CHILD CAREFACILITY NUMBER:
103911169
ADMINISTRATOR:WILBORN, PATRICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 840-1848
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Harpreet KaurTIME COMPLETED:
12:30 PM
NARRATIVE
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On 12/1/23, Licensing Program Analyst (LPA) Priscilla Zamudio arrived at the facility to conduct an unannounced Case Management inspection. LPA met with Assistant Harpreet Kaur. LPA toured the facility and a census was taken of 4 children.

The purpose of today's inspection was regarding an incident that was reported to the Fresno Childcare Regional Office on 11/16/2023. Per the report, licensee Patrice Wilborn, was not in the home during hours of operation and has not provided care for daycare children, due to being deployed out of the country, as of September 2023. Licensee was not in the home at the time of this inspection and could not be reached by phone. LPA interviewed assistant and obtained information about the current plan of operation in the daycare and provided information about how licensee will need to maintain in compliance with licensing regulations. LPA also discussed inactive requirements to assistant.

Based on information gathered and observations made by LPA, while licensee was out, she allowed two assistants to provide care alone as of September 2023, during the hours of operation from 7:00 am-5:30 pm. LPA advised assistant that per regulations, licensee shall be present in the home and temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. LPA also discussed reporting requirements per section 102416(a)(2). Ms. Kaur stated that Ms. Wilborn will possibly return by next month. She agreed to inform her about today’s visit and to contact licensing.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is cited on attached LIC809-D.

Exit interview conducted and report was reviewed with Assistant, Harpreet Kaur.
This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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 12/01/2023 12:05 PM - It Cannot Be Edited


Created By: Priscilla Zamudio On 12/01/2023 at 11:44 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: WILBORN, PATRICE FAMILY CHILD CARE
FACILITY NUMBER: 103911169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2023
Section Cited
CCR
102416(a)(2)

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102416.2 Reporting Requirements
(a) The licensee shall report the following
information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).
(2) Any change in household composition
including adults moving in or out of the home...
This requirement was not met as evidenced by:
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Based on interview and observation, the
licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
Licensee failed to report her deployment and operation status to licensing, allowing assistants to provide care on a daily basis while she has been away.
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Assistant will notify licensee about today's visit and inform her to contact licensing about next steps which may include inactive status or temporary closure by POC due date of 12/6/23.

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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:Cynthia Brannon
LICENSING EVALUATOR NAME:Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


LIC809 (FAS) - (06/04)
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