243809958-12-20-2024-04-CC-MHEA-DC5RR8-20241220121443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243809958
Report Date: 12/20/2024
Date Signed: 12/20/2024 12:15:49 PM

Document Has Been Signed on 12/20/2024 12:15 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:	GOMEZ, BERTHA FCC		FACILITY NUMBER:	243809958
ADMINISTRATOR/ DIRECTOR:	GOMEZ, BERTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 382-2612
CITY:	PLANADA	STATE: CA	ZIP CODE:	95365
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	12/20/2024
TYPE OF VISIT:	Office	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:56 AM
MET WITH:	Bertha Gomez		TIME VISIT/ INSPECTION COMPLETED:	12:25 PM

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An Informal Conference was conducted on December 20, 2024, at 11:00 AM at the Fresno Regional Child Care Office. In attendance today were Licensing Program Manager (LPM), Juvenal Moctezuma, Licensing Program Analyst (LPA) Miguel Herrera, and Licensee, Bertha Gomez, and Licensee's daughter, Olivia Gomez. The purpose of the informal conference was to discuss previous citation, of personal rights of children in care regarding a complaint that was received on 07/17/2024 and to discuss previous citations during annual inspections. LPM reviewed the deficiencies with Licensee and discussed how the Family Child Care Home (FCCH) will maintain compliance with the deficiencies cited below.

The Department of Social Services, Community Care Licensing Division has determined that Licensee, Bertha Gomez has violated the following licensing regulations pertaining to the operation of her Family Child Care Home:

The following Type A violations were discussed:

· 09/05/2024 CCR 102423(a)(4) Personal Rights: Based on interviews and records review, children's personal rights were violated while in care, this poses an immediate risk to the health, safety and/or personal rights of children in care.

· 09/13/2022 CCR 102416.3(a) Alterations to Existing Building or Grounds: Based on LPA Gibson’s observation and record review facility sketch, Licensee added additional rooms without proper permits, which poses an immediate health, safety, or personal rights risk to persons in care.

· 09/13/2022 CCR 102370(d) Criminal Record Clearance: Based on LPA Gibson’s observation and interviews, the Licensee allowed a family member to operate an eyelash business during day care hours and permitted customers to enter the licensed day care room, where children were present. through the licensed day care (photo was taken), which poses an immediate health, safety or personal rights risk to persons in care.

To be continued on 809-C.

Juvenal Moctezuma	TELEPHONE: (559) 650-7869
Miguel Herrera	TELEPHONE: (559) 341-0721
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 12/20/2024

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The following Type B violations were discussed:
· 09/13/2022 CCR 102425(j)(2) Infant Safe Sleep: Based on LPA Gibson’s record review, Licensee did not have current documentation for a chid on an infant sleep log that should have documented labored breathing, temperature, or signs of distress. Licensee stopped documentation in April of 2022, which poses a potential health, safety, or personal rights risk to persons in care.

Licensee has submitted proof of corrections for the above-mentioned citations, and the deficiencies were cleared.

In accordance with the regulations cited above, Licensee has agreed to the following:

1. Licensee agrees to comply with Title 22, Division 12, Chapter 3 of the California Code of regulations.

2. Licensee will ensure children are provided with a safe and healthful environment, and comfortable accommodations furnishing, and equipment at all times.

3. Licensee will ensure that children in care will be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.

4. Licensee will ensure that all individuals 18 years and older will obtain a California clearance or a criminal record exemption as required by the Department of Community Care Licensing prior to working, residing, or volunteering in their licensed facility.

5. Licensee will ensure that any areas that are inaccessible to children shall remain closed and made inaccessible during day-care hours.

6. Licensee will ensure to notify the Department prior to making alterations or additions to the family child care home or grounds.

7. Licensee will ensure to supervise infants while they are sleeping and adhere to documenting 15 minute check logs for infants 24 months and younger.

In addition, it was recommended that licensee connect with her local resource and referral agency for additional support and training. Licensee stated she already has contact information for her local resource and referral agency. Licensee was also informed about the Technical Support Program and Licensee agreed to seek services. LPA Herrera will make the referral to Technical Support Program. To be continued on 809-C.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 12/20/2024

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Today, Licensee was informed that any further repeats of the above deficiencies will result in a Non-Compliance Conference and possible referral to the Legal Division for possible Administrative Action. Furthermore, Licensee understands that any repeats of the above deficiencies within a 12-month period will result in the issuance of civil penalties. A copy of this report was given to Licensee, Bertha Gomez. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, No Deficiencies are cited during today’s Office Visit.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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