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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910423
Report Date: 05/12/2022
Date Signed: 05/12/2022 10:46:05 AM

Document Has Been Signed on 05/12/2022 10:46 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SANTOS, ANDREA FAMILY CHILD CAREFACILITY NUMBER:
203910423
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
05/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrea SantosTIME COMPLETED:
10:50 AM
NARRATIVE
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On 05/12/22, Licensing Program Analysts (LPAs) Angelica Slaughter and Stephanie Vega-Gonzalez conducted an unannounced Case Management inspection to the facility. LPAs met with Licensee Andrea Santos. A tour of the facility was also conducted and a census taken.

The purpose of this inspection was to discuss criminal background clearance requirements for family child care facilities, due to a previous inspection visit, where LPA Slaughter was greeted at the door by an adult male. The individual refused to identify himself, only saying, he was a friend of licensee's husband and he was residing in the home as a tenant of the licensee. Licensee stated the individual was a friend of her daughter's husband. The individual worked as a farm laborer with her son-in-law. Licensee stated he had been printed. He no longer resides in the home and hasn't resided in the home in about two years. LPAs also discussed the matter of another individual listed on her roster who is not fully finger print cleared, but residing in the home. Licensee was advised to have the individual re-print as soon as possible to avoid any further issues. Licensee was further advised the individual must not remain at the residence while they wait for their full clearance to be granted. Licensee understood and stated she would comply.

LPA advised Licensee that prior to working, residing, or volunteering in a licensed facility, all individuals subject to a criminal record review must obtain criminal record clearance.
LPA reviewed criminal background requirements and exemption criteria with Licensee. Licensee understands that she must obtain criminal record clearance for any employee that works within her family child care home prior to employment.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, a deficiency was cited today.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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Document Has Been Signed on 05/12/2022 10:46 AM - It Cannot Be Edited


Created By: Angelica Slaughter On 05/12/2022 at 10:25 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: SANTOS, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 203910423

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2022
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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Licnesee will have the individual re-print within the next 72 hours. Indivdual is not to be present in the facilty until they obtain a full clearance. POC due date of 05/15/22.
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Review of Licensee's facility roster and this inspection. Indvidual #1 has only a partial finger print clearance. This posses 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.
SUPERVISOR'S NAME:Diana deLeon
LICENSING EVALUATOR NAME:Angelica Slaughter
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022


LIC809 (FAS) - (06/04)
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