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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620260
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:09:58 PM

Document Has Been Signed on 08/23/2023 03:09 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:DOMINGUEZ, JESSICA FAMILY CHILD CAREFACILITY NUMBER:
155620260
ADMINISTRATOR:DOMINGUEZ, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 501-1165
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/23/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jessica DominguezTIME COMPLETED:
03:15 PM
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On 8/23/23, Licensing Program Analyst (LPA), Norma Lomeli met with Spanish-speaking Applicant, Jessica Dominguez for a pre-licensing inspection. Applicant, her husband, and her adult daughter reside in the home. Background clearances are discussed and LIS 531 is signed. Fire clearance was granted on 8/4/23.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on 8/11/23. Fire pull alarm is located on the home’s entry way on the left hand side wall.
  • This is a two story home with three bedrooms and two and a half bathrooms and a Next Gen room with a bathroom (day-care rooms). Children will have access to the Next Gen room and the bathroom. Off-limits rooms/ closets are made inaccessible by use of a plastic door knob covers and a dead bolt lock. The upstairs area will be off-limits to the day-care children. There door that will be kept locked with a dead bolt lock.
  • There is central cooling/ heating air ventilation for safety and comfort.
  • LPA observed in the day care rooms; children size furniture, safe toys, and books for the children. There two flat screen televisions and a parents board mounted onto the wall. There are colorful alphanumeric area rugs. There is a diaper changing station. There is an infant swing and a high chair. There is a refrigerator and microwave. Children will nap in day care room on cots or mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times. 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: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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: DOMINGUEZ, JESSICA FAMILY CHILD CARE
FACILITY NUMBER: 155620260
VISIT DATE: 08/23/2023
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  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant and Applicant’s Assistant, Lori Dominguez completed the Pediatric CPR and First Aid certification through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on 2/12/24.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on 2/14/22.
  • Knives are stored inside top cabinet in the day care room. Medications are stored in the master bedroom. Cleaning compounds are stored inside the cabinet that is located underneath the kitchenette sink and made inaccessible by the use of a child proof safety latch.
  • 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.
  • There is a dog that is kept in a room inaccessible to the daycare children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are kept locked inside a storage shed that is located in the backyard.
  • 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: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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: DOMINGUEZ, JESSICA FAMILY CHILD CARE
FACILITY NUMBER: 155620260
VISIT DATE: 08/23/2023
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  • Fenced backyard has a designated cemented and wood chip play area for the day care children. There is a wooden swings/slide play structure that is anchored to the surface. There are two picnic tables, tricycles, a basketball hoop, a Backyard Discovery wooden play house, and other safe toys. There is a shade sail for shade.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on 4/12/22.
  • 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 7:30 AM to 5:30 PM 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: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 3 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: DOMINGUEZ, JESSICA FAMILY CHILD CARE
FACILITY NUMBER: 155620260
VISIT DATE: 08/23/2023
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Applicant is advised the following item must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
  • Applicant will provide Fresno CCL with fingerprints clearances of adult that resides in the home.

Pending verification of correction of the above item and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4