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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911753
Report Date: 01/12/2023
Date Signed: 01/12/2023 04:36:03 PM

Document Has Been Signed on 01/12/2023 04:36 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:ROBLES, JOANNA FAMILY CHILD CAREFACILITY NUMBER:
153911753
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/12/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Joanna Robles - Licensee TIME COMPLETED:
04:45 PM
NARRATIVE
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On 1/12/23, an unannounced Case Management inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA Thompson met with Joanna Robles, and toured the facility, inside and outside. Facility is operating Monday through Friday, from 6:00 AM to 6:00 PM with one child currently enrolled. The purpose of today's inspection was to conduct a post licensing follow-up on the initial pre-licensing inspection that took place on 8/03/22. Accessible rooms are the living room, dining/kitchenette area, bedroom #1 and bathroom. Off-limit areas are made inaccessible by use of door locks. There are no bodies of water or weapons at this residence. Children's files were reviewed and LPA discussed with licensee the requirement of maintaining a Children’s Roster and completing fire and disaster drills every six months. Required forms are posted. Safe sleep regulations were discussed.

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: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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