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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620489
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:24:12 PM

Document Has Been Signed on 06/20/2024 03:24 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SITU, XIAO FAMILY CHILD CAREFACILITY NUMBER:
155620489
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Xiao SituTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 6/20/24, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Xiao Situ for a pre-licensing inspection. Applicant, her Fiancé, and one minor child 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, four bedrooms and two bathrooms home and children will have access to the living room (day care room), dining room, kitchen and hallway bathroom. Off-limits rooms/ closets are made inaccessible by use of plastic door knob covers and a child proof safety gates.
  • There is a fireplace in the living room that applicant states it will not be used during day-care hours. There is central air heating/cooling ventilation for safety and comfort.
  • LPA observed in the day care room; child size table and chairs, safe toys, books and a diaper changing table. There is a flat screen television mounted on to the day care room wall. There is a parents board mounted onto the right side of the home's entry way. Children will nap in living room on 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.
  • Facility has 3A40BC fire extinguisher that is located in the pantry. There is a smoke alarm, carbon monoxide alarm and first aid kit in place.
(Continued on LIC809-C):
SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SITU, XIAO FAMILY CHILD CARE
FACILITY NUMBER: 155620489
VISIT DATE: 06/20/2024
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  • Applicant’s Pediatric CPR and First Aid certification was completed through EMS Safety with Emergency Medical Services Authority stickers (EMSA) and expires on 1/5/26.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on 2/8/4.
  • Knives are stored inside a kitchen drawer that is made inaccessible by the use of a child proof safety latch. Medications are stored inside the refrigerator on a top shelf. Other medications are stored inside the inaccessible pantry on a top shelf. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof sliding cabinet latch. Other cleaning compounds are stored inside a top cabinet in the laundry room.
  • 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. LPA observed a dried pond that is located in the backyard. Applicant states it will not be filled with water.
  • Applicant states there are no pets in the home or on the premises.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are stored inside a cabinet in the garage that is not locked.
  • 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: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SITU, XIAO FAMILY CHILD CARE
FACILITY NUMBER: 155620489
VISIT DATE: 06/20/2024
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  • Fenced backyard has a cemented and sodded area that will not be accessible to the day care children. Applicant states that the door that leads to the backyard will be locked during day care hours.
  • Applicant completed the Mandated Reporter Training on 9/24/23.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • SB 792 immunizations are on file.
  • Applicant is advised it is her responsibility to read and be incompliance with Title 22 Regulations. Regulations can be found at www.ccld.ca.gov.
  • Applicant is advised Fresno Community Care Licensing Department has inspection authority and can inspect all rooms in the home, garages and/or separate dwellings on the premises.
  • 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 6:00 AM to 6:00 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.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SITU, XIAO FAMILY CHILD CARE
FACILITY NUMBER: 155620489
VISIT DATE: 06/20/2024
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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 store all the poisons located in the garage under key lock.

Pending verification of correction of the above item 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: Gloria Reyes
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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