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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909601
Report Date: 12/06/2023
Date Signed: 12/06/2023 01:11:10 PM

Document Has Been Signed on 12/06/2023 01:11 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:QUIROZ, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
243909601
ADMINISTRATOR:QUIROZ, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 398-0644
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Carmen QuirozTIME COMPLETED:
01:30 PM
NARRATIVE
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On 12/6/2023, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced Case Management Visit regarding an unrelated matter. LPA met with Licensee, Carmen Quiroz. LPA explained the reason of the inspection and toured the facility, inside and outside and a census was taken of 3 children.

LPA discussed an incident reported to licensing on or about 12/1/23, regarding licensee admitting to use of an "off limits" area, allowing a child to sleep on a couch.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and a copy of report and appeal rights were provided and discussed with Licensee, Carmen Quiroz.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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 12/06/2023 01:11 PM - It Cannot Be Edited


Created By: Priscilla Zamudio On 12/06/2023 at 12:53 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: QUIROZ, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 243909601

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2023
Section Cited
CCR
102416.3(a)

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(a) 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: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
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Licensee stated that she does plan to use any "off-limit" areas and will notify licensing in the future if plans change. Deficiency cleared.
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Based on interviews, the licensee did not comply with the section cited above in that an off limit area was being used for day care children, which 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:Cynthia Brannon
LICENSING EVALUATOR NAME:Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


LIC809 (FAS) - (06/04)
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