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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911501
Report Date: 08/03/2022
Date Signed: 08/03/2022 10:29:17 AM

Document Has Been Signed on 08/03/2022 10:29 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PEREZ, VIRIDIANA FAMILY CHILD CAREFACILITY NUMBER:
103911501
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Viridiana PerezTIME COMPLETED:
10:45 AM
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On 8/3/22 Licensing Program Analyst (LPA) Caroline Harris conducted a unannounced Case Management inspection. LPA met with Viridiana Perez and toured the home. A census was taken and there were eight children present, three infants (ages 0-24 months old) and five older children, placing the licensee out of ratio.

The purpose of the inspection was to clear deficiencies that were previously cited on 7/13/22. LPA reviewed the assistants file and observed all required copies of licensing forms and required information, including immunizations and Mandated Reporter training. The licensee was also documenting 15 minute checks for infants 0-24 months old.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. An exit interview was conducted with Viridiana Perez. Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were cited during today’s inspection.

A copy of this report along with appeal rights and LIC 9213 Notice of Site Inspection were provided to the licensee Viridiana Perez. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be 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: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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 08/03/2022 10:29 AM - It Cannot Be Edited


Created By: Caroline Harris On 08/03/2022 at 09:43 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: PEREZ, VIRIDIANA FAMILY CHILD CARE
FACILITY NUMBER: 103911501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2022
Section Cited
CCR
102416.5(b)(3)

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For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
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The licensee had 1 infant picked up, placing her in ratio. The LPA and licensee reviewed ratio break downs and the LPA gave the licensee a packet of ratio examples and reviewed the regulation with the licensee.
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More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. This requirement was not met as evidenced by the licensee having eight children present (3 infants, 5 older children). This is a possible risk to the health, safety or personal rights of children 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:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
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