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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620010
Report Date: 09/15/2022
Date Signed: 09/15/2022 04:04:51 PM

Document Has Been Signed on 09/15/2022 04:04 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:RODRIGUEZ, ANA FAMILY CHILD CAREFACILITY NUMBER:
155620010
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ana RodriguezTIME COMPLETED:
12:45 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On September 15, 2022, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Ana Rodriguez for a pre-licensing inspection. Applicant, her husband, and two minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • This is a single story, two bedrooms and two bathrooms home and children will have access to the living room, dining room and bathroom #1. Off-limits rooms, closets and/or cabinets are made inaccessible by use of lever locks, child safety gates and magnetic cabinet locks.
  • LPA did not observe a fireplace in the home.
  • LPA observed children size furniture, safe toys, and books for the children. There is a flat screen television mounted onto the living room wall. LPA observed several steps leading to the living room and other steps leading to the bathroom #1. LPA and applicant discussed the potential dangers of the steps; as a tripping hazard and sharp edges can can cause injury to a child. LPA recommended that applicant secures the sharp edges with some type of cushion barrier. Applicant understands she is to supervise children at all times. Children will nap in the living room on mats. Infants will nap in play yards. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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 4
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, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620010
VISIT DATE: 09/15/2022
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  • Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant’s Pediatric CPR and First Aid certification was completed through American Red Cross and expires on June 19, 2023.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on June 16, 2022.
  • Knives and medications are stored inside kitchen cabinet. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof safety locks. Applicant states that the kitchen will be an area inaccessible to the day care children as designated on the home’s facility sketch. Applicant states that she ordered a gate to make the kitchen inaccessible.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant 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.
  • There are no bodies of water in the home or premises
  • Applicant states there are no pets in the home or on the premises.
  • Applicant states there are no firearms, ammunition or poisons in the home or premises.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant 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). Applicant states the home is smoke-free.
  • Applicant states she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620010
VISIT DATE: 09/15/2022
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  • Fenced backyard has a fenced designated play area for the day care children. Applicant states that she will walk the day care children out her front door entrance, through her chain link fenced front yard to get to the back yard play area. LPA observed tricycles, scooter and other safe toys. There is a a patio porch for shade. LPA also observed a trampoline with a netted enclosure and a swing/slide play structure that applicant states they will both be inaccessible to the day care children.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on August 22, 2024.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 5:00AM to 5:00PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant 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.



(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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: RODRIGUEZ, ANA FAMILY CHILD CARE
FACILITY NUMBER: 155620010
VISIT DATE: 09/15/2022
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Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
  • Applicant will provide proof that she has made the kitchen inaccessible to the day care children as identified on her home's facility sketch.

Pending verification of correction 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.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
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