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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911693
Report Date: 07/14/2022
Date Signed: 07/14/2022 03:56:24 PM

Document Has Been Signed on 07/14/2022 03:56 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:MUNOZ, ANASTACIA FAMILY CHILD CAREFACILITY NUMBER:
153911693
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
07/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Anastacia Munoz - Licensee TIME COMPLETED:
04:15 PM
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On 7/14/22, an unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA Thompson met with licensee, Anastacia Munoz and toured the facility, inside and outside. Facility is operating Monday through Friday, from 7:00 AM to 5:30 PM . The purpose of today's inspection was to conduct a 90 Day follow-up on the initial pre-licensing inspection that took place on 6/14/22. Accessible rooms are the living room, master bedroom (day care room) and master bathroom (day care bathroom). Off-limits rooms are made inaccessible by the use of plastic door knob covers and baby gates. There are no "bodies of water" or weapons at this residence. Children's files were reviewed and were in compliance. Licensee maintains a current Children’s Roster. LPA advised licensee to ensure that she completes a fire and disaster drills every six months, documenting the date and time. Required forms are posted. The backyard is accessible to children and is free of hazards. Safe sleep regulations were discussed. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPA discussed water play safety with Licensee. Provider Information Notices were discussed, and licensee is aware that forms and updated information may be obtained on the Department's website (www.ccld.ca.gov). LPA discussed Required 1-Year inspections with the licensee, detailing what to expect. Reporting requirements were discussed and Licensee understands that unusual incidents must be reported the Fresno Community Care Licensing office during the Department's normal business hours, before the close of the next working day following the occurrence. Incidental Medical Services (IMS) policy were discussed. Currently, Licensee does not have any children enrolled requiring IMS. Licensee understand that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies were cited today.

An exit interview was conducted with Licensee and appeal rights were provided.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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