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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203908603
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:08:01 AM

Document Has Been Signed on 03/15/2023 11:08 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:VARGAS, MARIA FAMILY CHILD CAREFACILITY NUMBER:
203908603
ADMINISTRATOR:VARGAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 481-5134
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:MARIA VARGASTIME COMPLETED:
11:30 AM
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On 3/15/2023, Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez and Licensing Program Manager (LPM) Juvenal Moctezuma conducted a Case Management- Incident Inspection. LPA and LPM met with Licensee, Maria Vargas and explained the reason of the inspection. Maria greeted LPA & LPM inside the home and observed Maria caring for 4 children. LPA and LPM conducted a tour of facility and a census was taken. LPA and LPM interviewed Licensee Maria Vargas and Assistant and reviewed facility records.

Licensee informed licensing on 2/17/2023 via a submitted unusual incident report that Child #1 sustained an injury while in care. LPA was informed that Child #1 had thrown a tantrum and threw themselves backwards. At the same time, assistant caught child by their arms to prevent child from falling backwards and potentially hitting their head. Within the hour, parents were contacted and picked up child #1. Child was taken to their doctor where it was confirmed that they had dislocated their right arm. Licensee indicated that they have provided guidance and training to assistant on how to better handle children with behavior problems.

This is an isolated incident. Child #1 was cleared and returned to care on February 27, 2023. Licensee confirmed that there are no residual medical complications with the child.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, No deficiencies were cited during todays inspection.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Maria Vargas

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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