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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203911515
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:16:48 PM

Document Has Been Signed on 08/02/2023 03:16 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:PEREZ, LORENA FAMILY CHILD CAREFACILITY NUMBER:
203911515
ADMINISTRATOR:PEREZ, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 269-6207
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 8DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lorena PerezTIME COMPLETED:
03:20 PM
NARRATIVE
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On 08/02/23 Licensing Program Analyst (LPA) Denisia Jimenez conducted an unannounced case management inspection to address the additional room licensee added last year. LPA met with licensee Lorena Perez who is caring Licensee converted the patio into an additional room. LPA gave licensee form LIC9054 Fire Inspection Authority to request a new fire clearance. Licensee failed to report to Community Care Licensing the additional room, therefore Licensee is in violation of the California Code of Regulations 102416.3 (a)(4)- Alterations to Existing Buildings or Grounds. LPA will issue a Type B citation.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiency is being cited on the attached LIC 809D. A type B citation was issued during today's inspection. Lorena was provided with her appeal rights.
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. Exit interview conducted and report was reviewed with Licensee – Lorena Perez.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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Document Has Been Signed on 08/02/2023 03:16 PM - It Cannot Be Edited


Created By: Denisia Jimenez On 08/02/2023 at 03:03 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: PEREZ, LORENA FAMILY CHILD CARE
FACILITY NUMBER: 203911515

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2023
Section Cited
CCR
102416.3(a)(4)

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Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
Construction of exterior decks or porches.
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LPA gave licensee form LIC9054 Fire Inspection Authority requesting a new fire clearance. Licensee has until 09/02/23 to get the fire clearance approved.
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This requirement was not met as evidence by:
Licensee failed to report the conversion of the patio to an additonal room. This poses a potential health & safety risk to children 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:Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
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