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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910359
Report Date: 05/09/2025
Date Signed: 05/09/2025 03:07:22 PM

Document Has Been Signed on 05/09/2025 03:07 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PALLARES, ANASTACIA FAMILY CHILD CAREFACILITY NUMBER:
153910359
ADMINISTRATOR/
DIRECTOR:		PALLARES, ANASTACIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 513-9681
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/09/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Anastacia PallaresTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On May 9, 2025, at approximately 7:30 AM, Licensing Program Analyst (LPA) Paul Garcia, conducted an unannounced Case Management - Plan of Correction (POC) Inspection. Upon arrival LPA met with Licensee Anastacia Pallares. LPA explained that the purpose for the inspection was to ensure compliance with POC(s) related to deficiencies cited on February 27, 2025.

LPA took a census and observed capacity to be within ratio. LPA observed six (6) children and one (1) infant in care with licensee only. During the inspection LPA asked Anastacia the names of all adults currently in the home. All names provided matched known cleared criminal record adults residing in the home with the exception of resident #1 (R1) who is subject to a criminal record review pursuant to Health and Safety Code Section 1596.871, shall prior to working, residing, or volunteering in a licensed facility obtain a California clearance or a criminal record exemption as required by the Department and conditions of licensure. LPA contacted the Care Provider Management Branch (CPMB) telephonically and verified with operator #1 (O1) that (R1) is not cleared by the department.


Per licensee, (R1) moved in on April 21, 2025, and is the boyfriend of her adult live in daughter.
  • LPA checked agreed upon compliance with deficiencies cited on February 27, 2025, pertaining to AB2866 - The Pool Safety Act and observed that licensee meet the terms satisfying compliance with POC.
  • LPA observed documentation that Staff #1 (S1) is now CPR certified as of March 6, 2025, allowing a pathway to provide transportation to children in care.
NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Paul Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/09/2025 03:07 PM - It Cannot Be Edited


Created By: Paul Garcia On 05/09/2025 at 10:55 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: PALLARES, ANASTACIA FAMILY CHILD CARE
FACILITY NUMBER: 153910359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2025
Section Cited
CCR
102370(d)(1)

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102370 (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Anastacia agrees that (R1) will not be present on the property during childcare operational hours or until the department has issued a criminal record clearance for him/her.

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Based on interview with licensee and her assistant, licensee failed to ensure (R1) received a criminal record clearance prior to residing in her licensed child care home which poses an immediate Safety or Personal Rights risk to children in care.
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The licensee will also provide a handwritten letter stating that she understands 102370(d)(1) then submit document to the case-carrying analyst by May 12, 2025

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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.
Cynthia Brannon
NAME OF LICENSING PROGRAM MANAGER:
Paul Garcia
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025


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: PALLARES, ANASTACIA FAMILY CHILD CARE
FACILITY NUMBER: 153910359
VISIT DATE: 05/09/2025
NARRATIVE
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LPA cleared deficiencies cited on February 27, 2025. LPA provided licensee letters of cleared deficiencies during today’s inspection. Provided letters must be filed in the facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations one (1) Type A deficiency was cited today with a civil penalty of $500.00 for the absence of a criminal record clearance for (R1) before residing in the home as required. LPA informed licensee that (R1) is not cleared to live in the home and must vacate the home until (R1) obtains a California clearance or a criminal record exemption as required by the Department or is present only during non-operational hours.



LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

An exit interview was conducted, and this report was reviewed with Anastacia Pallares and (S1).

Appeal rights were discussed and provided.

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Paul Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC809 (FAS) - (06/04)
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