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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203911380
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:44:01 PM

Document Has Been Signed on 03/07/2023 01:44 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BARRAGAN, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
203911380
ADMINISTRATOR:BARRAGAN, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 780-5611
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Angelica BarraganTIME COMPLETED:
01:55 PM
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On 3/7/2023 Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez conducted an unannounced Case Management Inspection at facility. The purpose of the inspection was to inspect the “off-limits” backyard that was made effective on 01/26/2023 and to review the Plan of Corrections (POCs) that are past due. Today, LPAs met with licensee's Assistant Alexandra Barragan. Licensee, Angelica Barragan soon arrived at facility at 11:30am. LPA toured the facility, and a census was taken of 6 children in care.

On today's visit, LPA observed that there was no above ground pool in the extended backyard. LPA observed that Licensee had placed locks on her backyard gates that led to the extended backyard. LPA observed that the indoor sliding door had a sliding window lock which made the backyard inaccessible to children in care. A current Facility Sketch reviewed and updated on today's date. As of today the backyard is "Off-limits" to children in care. Licensee stated that lock will be on sliding door during child care hours. LPA observed that front yard was cleaned, and that all debris and the parked car with damaged car hood with exposed car part was removed.

Effective today, 03/07/2023, the facility may begin using front yard for day care children. Licensee stated that front yard's gate to main road will be closed while children use front yard.



Upon record review, LPA observed that 3 out of 5 children did not have the LIC 9224 Acknowledgement of Receipt of Licensing Reports form. LPA observed that Licensee had not updated their Mandated Reporter training, and they had not updated the LIC 9040 Children's Roster form.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

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 Angelica Barragan.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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 3
Document Has Been Signed on 03/07/2023 01:44 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 03/07/2023 at 11:47 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: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
102419(d)(1)

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102419(d)(1) Admission Procedures and Parental and Authorized Representative's Rights(d)At the time of ... a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06),..Based on record review, the licensee did not comply with the section
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Licensee stated that they will submit proof of signed forms to CCL by POC due date. Licensee stated that they will make sure parents complete all forms before caring for children.
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cited above in that LPA observed that 3 out of 5 children did not have the LIC955A document on file which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
03/10/2023
Section Cited
HSC1596.8662(b)(1)

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1596.8662(b)(1) Administration of Child Day Care Licensing(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the
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Licensee stated that they will complete their mandated reporter training and submit it to CCL by POC due date.
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mandated reporter training provided pursuant to paragraphs ... Based on record review, the licensee did not comply with the section cited above in that LPA observed during record review that Licensee had not completed their mandated reporter training which poses/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.
SUPERVISOR'S NAME:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2023 01:44 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 03/07/2023 at 01:28 PM
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: BARRAGAN, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 203911380

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
102417(g)(8)

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102417(g)(8) Operation of A Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. Based on record review, the licensee did not comply with the section
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Licensee stated that they will complete a children's roster LIC9040 and provide proof to CCL by POC due date.
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cited above in that LPA observed during record reveiw that Licensee did not have an updated LIC9040 on file. which poses/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.
SUPERVISOR'S NAME:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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