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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911810
Report Date: 08/11/2022
Date Signed: 08/11/2022 09:45:32 AM

Document Has Been Signed on 08/11/2022 09:45 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:RODRIGUEZ, ELIM FAMILY CHILD CAREFACILITY NUMBER:
153911810
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elim RodriguezTIME COMPLETED:
10:00 AM
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 08/11/22, Licensing Program Analyst (LPA) Gloria Reyes conducted a case management inspection. LPA met with Licensee, Elim Rodriguez. The purpose of today's visit is to conduct a 90 Day follow-up on initial prelicensing visit. Licensee stated that since licensure she has not had any children. Background clearances were reviewed and verified. This facility is licensed as a small facility with a capacity of eight. A tour of the home, inside and outside, as shown on the facility sketch was done. The children will have access to the living room, dining room/kitchen and hallway bathroom. Off-limits rooms are made inaccessible by the use of key locks.

Required forms are posted. No children's files were reviewed today as there are no children in care. Licensee understands once she has children in care she must document immunizations and maintain and update records for children in care. Licensee understands that she must conduct fire and disaster drills at least once every six months and document the date and time of each drill. Fire extinguisher, smoke detector, carbon monoxide detector and first aid kit are operable and in place. Licensee stated there are no firearms or "bodies of water" in this home and nor did LPA observe these items. The backyard is off-limits to children.

Health and Safety training, Pediatric CPR, and Pediatric First Aid training are current and expires on 03/21/24. LPA verified that the required immunizations and the required Mandated Child Abuse Reporter (AB 1207) training was completed on 03/22/22.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. (see next page)

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Gloria Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, ELIM FAMILY CHILD CARE
FACILITY NUMBER: 153911810
VISIT DATE: 08/11/2022
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
26
27
28
29
30
31
32
LPA reviewed Safe Sleep guidelines with licensee. Days/Hours of Operation: Monday through Sunday, less than 24 hours, and as arranged.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency cited.

Exit interview conducted with licensee. A copy of this report was provided and discussed. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Gloria Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2