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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223911233
Report Date: 06/19/2025
Date Signed: 06/19/2025 11:01:36 AM

Document Has Been Signed on 06/19/2025 11:01 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:HENDERSON, SHANNON FAMILY CHILD CAREFACILITY NUMBER:
223911233
ADMINISTRATOR/
DIRECTOR:		HENDERSON, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 617-9767
CITY:CATHEYS VALLEYSTATE: CAZIP CODE:
95306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/19/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Shannon HendersonTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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On 06/19/2025, Licensing Program Analysts (LPA) Stephanie Vega-Gonzalez conducted a Case Management Plan of Correction inspection. The purpose of the inspection was to review the Plan of Correction for the deficiencies cited on 01/29/2025. Today, LPA met with licensee Shannon Henderson. LPAs toured the facility, and a census was taken. No day care children were present during the inspection.

The purpose of the inspection was to clear deficiencies that were cited on 01/29/2025. LPA was informed by licensee that she and her assistant do not have a current CPR & FA certificate on file. Licensee stated that she will register for course. During the inspection LPA observed the following in the front of the yard: a stock tank in the front yard filled with water. Licensee stated that tank water will be dumped out before children are present. LPA observed a propane tank, furniture in disrepair, clutter, and wood pieces. In the side balcony by sliding door, LPA observed furniture in disrepair and clutter. The children’s backyard LPA observed, stairs with no baby gate, toys in disrepair, pieces of wood, exposed wires, an outdoor sink with clutter inside, an opening on the side of the home. Licensee stated that she is closed for the day and that she is cleaning the areas. Licensee stated that areas will be cleared off before children are present.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Licensee was provided 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. Failure to comply with posting requirements shall result in an immediate civil penalty.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Stephanie Vega-Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/19/2025 11:01 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 06/19/2025 at 10:36 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: HENDERSON, SHANNON FAMILY CHILD CARE
FACILITY NUMBER: 223911233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid,...
This requirement is not met as evidenced by:
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Licensee stated that they will register for a CPR and FA course and provide proof to the Department that they have registered for the CPR & FA course. Licensee will also submit proof of completion of CPR and FA for her assistant/assistants to the Department.
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Based on interview, Licensee and her assistant/husband do not have a current CPR certification. This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
06/23/2025
Section Cited
CCR102417

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102417 Operation of a Family Child Care Home (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidence by: LPA observed a small stock tank filled with water in the front of the home. No day care children were present.
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Licensee stated that she will clear all items as stated in LIC809 from the front, side, and back yard. Licensee stated that she will submit pictures to the Department of the front yard, side yard, and back yard. Licensee will submit proof to the
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LPA observed various toys in the back yard that were need of repair or removal, LPA observed various indoor electric outlets not covered...as stated in LIC809 report. This poses a potential risk to the health, safety and personal rights of children in care.
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Department by POC due date of 6/23/2025. Licensee stated that areas will be ready for children in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joseph Pacheco
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Vega-Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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