<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910049
Report Date: 08/03/2022
Date Signed: 08/03/2022 04:09:20 PM

Document Has Been Signed on 08/03/2022 04:09 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:CONTRERAS, BERTHA FAMILY CHILD CAREFACILITY NUMBER:
153910049
ADMINISTRATOR:CONTRERAS, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 621-1398
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
08/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Bertha Contreras - Licensee TIME COMPLETED:
04:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/3/22, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Bertha Contreras to review POCs associated to deficiencies cited on 6/29/22. Today, LPA verified the following:
  • Licensee maintains proof of immunization, proof of Family Child Care Home Notification of Parent's Rights (LIC 995A), and proof of Emergency Medical Consent (LIC627) forms for children in care
  • Licensee has repaired the backyard perimeter fence; it is now upright
  • Licensee maintains proof of Child Abuse Mandated Reporter completion, for Staff #2, completed 7/28/22


LPA cleared the aforementioned deficiencies on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for reviewed.

Licensee was unable to provide proof of measles, whooping cough and influenza for Staff #2 and Staff #3, which was due by 7/29/22; therefore, Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC 809 D). Licensee was provided a copy of appeal rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/03/2022 04:09 PM - It Cannot Be Edited


Created By: Jessika Thompson On 08/03/2022 at 03:50 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: CONTRERAS, BERTHA FAMILY CHILD CARE
FACILITY NUMBER: 153910049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2022
Section Cited
HSC
1597.622(c)

1
2
3
4
5
6
7
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that she will submit proof of measles, whooping cough, and influenza immunization for S2 and S3, to the Fresno Community Care Licensing Office by 8/22/22.
8
9
10
11
12
13
14
Based on records review, the licensee did not comply with the section cited above, as today, Licensee was unable to provide LPA with proof of measles, whooping cough, and influenza immunization for S2 and S3. This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2