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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908072
Report Date: 05/29/2024
Date Signed: 05/29/2024 07:51:27 AM

Document Has Been Signed on 05/29/2024 07:51 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:
05/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:00 AM
MET WITH:Maria JuarezTIME VISIT/
INSPECTION COMPLETED:
07:45 AM
NARRATIVE
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On Wednesday, May 29, 2024, Licensing Program Analyst (LPA) Paul Garcia conducted an unannounced Case Management inspection. LPA Garcia met with Maria Juarez and explained the purpose for the visit.

The purpose for the visit was to follow up on a telephonic Unusual Incident Report (UIR) that was received by Community Care Licensing’s officer of the day on Friday, March 22, 2024, however, the incident 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 a serious incident that occurred as required within the next business day.

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

An exit interview was conducted, and this report was reviewed with Maria Juarez.

This report shall be made available to the public upon request.

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

Appeal rights were discussed and issued.
SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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Document Has Been Signed on 05/29/2024 07:51 AM - It Cannot Be Edited


Created By: Paul Garcia On 05/28/2024 at 06:30 PM
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: JUAREZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 153908072

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2024
Section Cited
CCR
102416.2(b)(3)(C)

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Reporting Requirements. (b)The licensee shall report to the Department any of the events... that occur during the operation of the family child care home. (3) Health and Safety Code Section 1597.467(b)(1) provides in part: (B) any injury to any child that requires medical treatment.
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licensee agrees to review the reporting requirements training on the CCL website and submit a full one page hand written statement of what those requirements are. Written statment shall be mailed to CCL office no later than June 5, 2024.
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This requirement was not met as evidenced by, licensee did not report a unusual incident report to CCL by the next working day as requiered. This poses a potential Health and Safety and/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:Gloria Reyes
LICENSING EVALUATOR NAME:Paul Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024


LIC809 (FAS) - (06/04)
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