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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902186
Report Date: 12/20/2023
Date Signed: 01/29/2024 01:08:39 PM

Document Has Been Signed on 01/29/2024 01:08 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MARTINEZ, ANA & TERESA FAMILY CHILD CAREFACILITY NUMBER:
153902186
ADMINISTRATOR:MARTINEZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 835-9904
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ana and Teresa Martinez.TIME COMPLETED:
02:40 PM
NARRATIVE
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On 12/20/2023, an Informal Office Meeting was conducted via Zoom as licensees were unable to attend at the Fresno South Regional Office. In attendance at the meeting were Licensing Program Manager Luisa Gavoutian, Licensing Program Analyst (LPA) Lady Cabrera, and Licensees Ana and Teresa Martinez.

The purpose of this meeting was to discuss an incident that was reported to Community Care Licensing on 10/03/2022.

The following was discussed:

Conduct Inimical

Reporting Requirements

Responsibilities of Mandated Reporter

Personal Rights

Recent violations of Title 22 regulations was discuss, that if not corrected, would pose an immediate and potential risk to the health, safety, and personal rights of children in care.



10/27/2023 Annual Deficiencies-

Type B Deficiency:

102417(g)(4) Poisons and cleaning compounds

Type B Deficiency:

1596.8662(b)(1) Mandated Reporter training

SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186
VISIT DATE: 12/20/2023
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Type B Deficiency:

102421(a) Children records

Type B Deficiency:

102425(c) Individual Infant Sleeping Plan (LIC9224)

It was discussed that continued violation of Title 22 regulations and failure to maintain compliance will result in a Non-Compliance Conference and may be referred to Legal Division for possible Administrative Action.



No deficiencies cited during today’s visit.

A copy of this report was emailed to Ana and Teresa Martinez, today, 12/20/2023.
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC809 (FAS) - (06/04)
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