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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910689
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:56:33 AM

Document Has Been Signed on 03/12/2025 11:56 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MORENO, BERTHA FAMILY CHILD CAREFACILITY NUMBER:
203910689
ADMINISTRATOR/
DIRECTOR:		MORENO, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 975-5911
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
03/12/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:MORENO, BERTHATIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 03/12/2025, Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez conducted a Case Management. LPA met with Licensee, Bertha Moreno and toured the facility, and a census was taken.

The purpose of the inspection was due to the Department receiving confirmation of the removal of Staff #1. LPA explained to Licensee that Staff #1 cannot work, reside, or be present at this facility unless a criminal record exemption is granted. Pursuant to state law, an exemption may be granted if the Caregiver Background Check Bureau (CBCB) is in receipt of substantial and convincing evidence that the individual is of present good character. Licensee indicated that the individual named on the form had not been present or worked at the facility since July of 2023.

Based on the statements and information obtained during today’s visit, the LPA has verified that Staff #1 is no longer present or employed at this facility since July of 2023. LPA obtained a signed roster report.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Appeal rights were printed and provided.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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