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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908072
Report Date: 06/25/2024
Date Signed: 06/25/2024 11:33:58 AM

Document Has Been Signed on 06/25/2024 11:33 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:JUAREZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
153908072
ADMINISTRATOR/
DIRECTOR:		JUAREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 589-8869
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/25/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Maria JuarezTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On June 25, 2024, an Informal Office Meeting was conducted at the Fresno South Regional Child Care Office. In attendance at the meeting was licensee, Maria Juarez. Also present was Licensing Program Manager, Gloria Reyes, and Licensing Program Analyst, (LPA) Paul Garcia.


The following issues/violations was discussed:

Type A Deficiency cited on May 29, 2024

Type A Deficiency cited: 102423(a)(2) Personal Rights.

Based on the investigation completed by Investigator Lomeli with the Department of Social Services Community Care Licensing Investigations Branch (IB), it was determined neglect resulted in licensee’s dog who bit Child 1 (C1). C1 sustained a superficial puncture wound over the dorsum of the right hand as well as the palmar aspect of the wrist. There was also a three-centimeter laceration to the radial aspect of the right wrist, and it was repaired with three sutures. A splint was applied for an open buckle fracture of the right forearm due to neglect which resulted in a personal rights violation to C1, that was found to be substantiated.



Continued on LIC809-C
SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: JUAREZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 153908072
VISIT DATE: 06/25/2024
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Type B Deficiency cited on May 29, 2024

Type B Deficiency cited: 102416.2(b)(3)(C) Reporting Requirements.

Based on a telephonic Unusual Incident Report (UIR) that was received by Community Care Licensing officer of the day on Friday, March 22, 2024, reported by Maria Juarez pertained to a serious injury to child 1 (C1) that resulted in required medical treatment that occurred seven (7) days prior on Friday, March 15, 2024.



Maria Juarez failed to follow reporting requirements as seven (7) days had passed until she notified Community Care Licensing of the serious incident that had occurred as required per Title 22 regulations, within the next business day.

On May 29, 2024, Maria Juarez agreed to a plan of correction pertaining to reporting requirements. Maria agreed to view training videos on the CCLD website and to submit a full one page handwritten statement of what those requirements are. The written statement was agreed to be mailed to the CCLD office no later than June 5, 2024, but was never received until June 25, 2024.

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



This facility will be referred to our Technical Support Program (TSP) and Licensee Maria Juarez agreed to participate. .

A copy of this signed report was given to licensee, Maria Juarez.
SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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