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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153907939
Report Date: 03/23/2022
Date Signed: 03/23/2022 10:50:44 AM

Document Has Been Signed on 03/23/2022 10:50 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PACE, CARLA FAMILY CHILD CAREFACILITY NUMBER:
153907939
ADMINISTRATOR:PACE, CARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 664-8709
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carla PaceTIME COMPLETED:
11:00 AM
NARRATIVE
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On 3/23/22 a inspection was conducted by Licensing Program Analyst (LPA) Caroline Harris. LPA met with licensee Carla Pace and a census was taken. The purpose of this report is to cite a violation which was discovered during the inspection.

Records show that the licensee, Carla Pace did not report an incident that occurred on 3/18/22 at her day care, to the Fresno CCL office with in 24 hours.

California Code of Regulations, Title 22, Division 12, Chapter (1), are being cited on the attached LIC 9099D.

An exit interview was conducted with Carla Pace. A printed copy of this report as well as appeal rights were provided to Carla Pace at the conclusion of the visit. A Notice of Site Visit is to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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 03/23/2022 10:50 AM - It Cannot Be Edited


Created By: Caroline Harris On 03/23/2022 at 10:36 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: PACE, CARLA FAMILY CHILD CARE
FACILITY NUMBER: 153907939

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2022
Section Cited
CCR
102416.2(b)

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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A)
through (b)(1)(C) that occur during the operation of the family child care home.
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The licensee completed an Unusual Incident Report and mailed it in to the Fresno CCL office on 3/21/22.
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This requirement was not met as evidenced by the licensee not reporting an incident that occurred at her day care on 3/18/22 to the Fresno CCL office with in 24 hours. 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:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022


LIC809 (FAS) - (06/04)
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