203912473-11-1-2024-04-CC-JYAZ-DALUA2-20241101152400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203912473
Report Date: 11/01/2024
Date Signed: 11/01/2024 03:24:11 PM

Document Has Been Signed on 11/01/2024 03:24 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	SANTOS-PACHECO, ANA FAMILY CHILD CARE		FACILITY NUMBER:	203912473
ADMINISTRATOR/ DIRECTOR:	SANTOS-PACHECO, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 718-8901
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/01/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Ana Santos-Pacheco		TIME VISIT/ INSPECTION COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/01/2024, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Ana Santos-Pacheco for a pre-licensing/change of location inspection. Applicant, her husband, her adult daughter and three minor children reside in the home. Background clearances are discussed and LIS 531/Roster Report were signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on October 9, 2024. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: · Fire clearance was received on October 9, 2024. Fire pull alarm is located on the home’s dining room wall. · On this date, 09/03/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. · This is a two story five bedroom, three and a half bathroom home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in the downstairs bedroom #1 and bathroom located inside, family room, dining room, living room, kitchen and half bathroom. (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SANTOS-PACHECO, ANA FAMILY CHILD CARE	FACILITY NUMBER: 203912473
	VISIT DATE: 11/01/2024

NARRATIVE

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Off-limit rooms are made inaccessible via plastic door knob cover. LPA did not observe a fireplace in the home.
· Applicant’s Pediatric CPR and First Aid certification was completed through HSI Pediatric with Emergency Medical Services Authority stickers (EMSA) and expires on February 15, 2025.
· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on August 8, 2024.
· Applicant completed the Mandated Reporter Training on January 30, 2024.
· SB 792 immunizations verified and on file.
· Applicant provided proof of control of property.
· In the family room, LPA observed children size furniture and safe toys. In bedroom #1, LPA observed children size furniture. Children will nap on mats, infants will nap on play yards in bedroom #1. Applicant understands she is to supervise children at all times.
· Fenced backyard has cement and dirt for the children. LPA observed patio chairs, a Little Tikes playhouse, and other safe toys.
· Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
· Knives are stored in a top kitchen cabinet. Medications are stored in the off-limits pantry. Cleaning compounds are stored in the upstairs laundry room.
· There are no bodies of water in the home or premises.
· Applicant states there are no pets in the home or on the premises.
· Applicant states there are no firearms or ammunition in the home or premises.
· Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
· Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
· Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a). (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SANTOS-PACHECO, ANA FAMILY CHILD CARE	FACILITY NUMBER: 203912473
	VISIT DATE: 11/01/2024

NARRATIVE

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· Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
· Applicant is advised Fresno Community Care Licensing Department has inspection authority and can inspect all rooms in the home, garages and/or separate dwellings on the premises.
· Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information and-resources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided applicant with Individual Infant Sleeping Plan and Safe Sleep handout.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SANTOS-PACHECO, ANA FAMILY CHILD CARE	FACILITY NUMBER: 203912473
	VISIT DATE: 11/01/2024

NARRATIVE

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A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant was advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Applicant states she will operate her day care Monday through Saturday from 4:30 am to 5:00 pm and as arranged. No overnight care will be provided.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities,
providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly
Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Pending a final review of application file, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective 11/04/2024. Exit interview conducted and report was reviewed with applicant.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

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