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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150407803
Report Date: 06/23/2022
Date Signed: 06/23/2022 11:08:43 AM

Document Has Been Signed on 06/23/2022 11:08 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:TREVINO FAMILY DAY CAREFACILITY NUMBER:
150407803
ADMINISTRATOR:TREVINO, VIKKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 871-6914
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Courtney ThomasTIME COMPLETED:
11:15 AM
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On 06/23/2022 Licensing Program Analyst (LPA) Nancy Her conducted an unannounced Case Management Inspection. LPA met with Assistant Courtney Thomas due to Licensee Vikki Trevino not being present.

LPA toured the home and a census of 8 children in care was taken . Assistant Courtney confirmed that the living room, dining room, kitchen, bathroom, bedroom 3 and the playroom and back yard are used for providing care and are accessible to children. During today's inspection, LPA observed medication tablets on the dining room table.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

LPA Nancy Her informed facility representative Courtney Thomas that this report dated 06/23/2022 document 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 Nancy Her informed the facility representative to provide a copy of this licensing report dated 06/23/2022 that documents any 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.

Exit interview was conducted and report was reviewed with the facility representative Courtney Thomas.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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 06/23/2022 11:08 AM - It Cannot Be Edited


Created By: Nancy Her On 06/23/2022 at 10:40 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: TREVINO FAMILY DAY CARE
FACILITY NUMBER: 150407803

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2022
Section Cited
CCR
102417(g)(4)

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

Based on observation, the licensee did not comply with the section cited above
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During today's inspection, Assistant Courtney Thomas removed medication and put them in an area that is inaccessible to children.
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During today's inspection, LPA observed two medication tablets sitting on the dining room table 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:Duane Matsubara
LICENSING EVALUATOR NAME:Nancy Her
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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