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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 165620175
Report Date: 07/27/2026
Date Signed: 07/27/2026 11:04:19 AM

Document Has Been Signed on 07/27/2026 11:04 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ACOSTA RODRIGUEZ, JESSICA FAMILY CHILD CAREFACILITY NUMBER:
165620175
ADMINISTRATOR/
DIRECTOR:		ACOSTA RODRIGUEZ, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 903-0018
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/27/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee Jessica Acosta RodriguezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On July 27, 2026, Licensing Program Analysts (LPAs) Xona Xayavong and Valentin Hernandez conducted an unannounced case management–other inspection. LPAs met with Licensee Jessica Acosta Rodriguez. LPAs toured the home inside and outside, and a census was taken. The purpose of the inspection was to follow up on the unusual incident report received by the Fresno Regional Office on May 18, 2026.

On May 12, 2026, Child #1 (C1) sustained second-degree burns to their left hand and forearm after coming into contact with a hot metal pole in the backyard of Licensee’s daycare home. Information obtained indicated that the weather may have reached approximately 98 degrees Fahrenheit, likely causing the pole to become hot.

However, Licensee did not report the unusual incident to Licensing until May 18, 2026, which is a violation of the reporting requirements regulations.

An exit interview was conducted, and the report was reviewed with Licensee Jessica Acosta Rodriguez. Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following (1) Type B deficiency is being cited: (see next page LIC 809-D).

Licensee was provided with appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and is required to be posted for 30 days.

Cynthia Brannon
Xona Xayavong
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/27/2026 11:04 AM - It Cannot Be Edited


Created By: Xona Xayavong On 07/27/2026 at 09:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ACOSTA RODRIGUEZ, JESSICA FAMILY CHILD CARE
FACILITY NUMBER: 165620175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2026
Section Cited
CCR
102416.2(b)(1)

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102416.2 Reporting Requirements (b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home…(1) Medical treatment means treatment by a medical professional, as defined in Section 101152(m). This requirement was not met by:
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Licensee shall ensure to report unusual incidents to the Department within the Department’s next business day and during normal working hours. The licensee will also provide a written statement confirming acknowledgment of the reporting requirement regulation and submit proof to Licensing by 08/10/2026.
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Based on record review and information obtained, the unusual incident occurred on May 12, 2026, and the licensee did not report the incident to Licensing until May 18, 2026, which posed a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Cynthia Brannon
NAME OF LICENSING PROGRAM MANAGER:
Xona Xayavong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
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