153911851-2-8-2023-57-CC-NLOI-CNURAR-20230208115134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153911851
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:52:07 AM

Document Has Been Signed on 02/08/2023 11:52 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:	GREEN, KARYN FAMILY CHILD CARE		FACILITY NUMBER:	153911851
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	02/08/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Karyn Green		TIME COMPLETED:	12:00 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 02/08/23, Licensing Program Analyst (LPA), Norma Lomeli conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection was licensee and three day care children. Licensee is the only person who resides in the home. Verified licensee CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on 06/26/23. Licensee’s Assistant, Blanca Escobar completed the training through EMS Safety with Emergency Medical Services Authority stickers (EMSA) and expires 01/20/25. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance or exemption. Fire clearance was granted on 01/30/23. A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed: Fire clearance was received on 02/01/23. Fire pull alarm is located on the hallway wall that leads to the downstairs accessible bathroom. LPA observed in the day care room; children size furniture, safe toys, books and a diaper changing table. LPA also observed three high chairs, a play yard and a crib. There is a parent’s board that is located on the right hand side wall of the home’s entry way. Licensee states she does not have weapons, firearms, ammunition or poisons in the home. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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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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: GREEN, KARYN FAMILY CHILD CARE	FACILITY NUMBER: 153911851
	VISIT DATE: 02/08/2023

NARRATIVE

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Facility has 2A10BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place.
Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
Licensee is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Licensee states the home is smoke-free.
Licensee states she does transport day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Required items are posted in the Child Care Home where parents may easily view.
During visit capacity worksheet was provided and discussed.
Licensee completed the Mandated Reporter Training but could not provide proof of certification. Licensee’s Assistant has not completed the training.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.

LPA & licensee discussed the Community Care Licensing website: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Licensee states her hours of operation are Monday through Sunday, 24 hours and as arranged. Licensee advised she does not provide care for more than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GREEN, KARYN FAMILY CHILD CARE	FACILITY NUMBER: 153911851
	VISIT DATE: 02/08/2023

NARRATIVE

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Licensee is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.

Licensee and licensee’s assistant will complete and provide proof of Mandated Reporter Training certification.

Pending verification of corrections of the above items and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

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