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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909809
Report Date: 11/02/2021
Date Signed: 11/02/2021 01:50:38 PM

Document Has Been Signed on 11/02/2021 01:50 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:AYALA, MANUEL & DOMINICA FAMILY CHILD CAREFACILITY NUMBER:
243909809
ADMINISTRATOR:AYALA, MANUEL & DOMINICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 384-3643
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/02/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Manuel and Dominica AyalaTIME COMPLETED:
12:00 PM
NARRATIVE
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An Informal Office Meeting was conducted today at the Fresno Regional Child Care Office. In attendance were: Licensees Manuel and Dominica Ayala, Licensing Program Analyst (LPA) Angelica Slaughter and Licensing Program Manager (LPM) Diana de Leon. The purpose of the meeting was to discuss recent violations of Title 22 Regulations.

LPM Diana de Leon also discussed other concerns the department has which were discovered through the course of an investigation. Reporting Requirements were discussed with the Licensees and a copy of the Regulations on Section 102416.2 was provided to the Licensees.

It was discussed with Licensees that continued violations of Title 22 Regulations could result in 1) a Non-Compliance meeting, 2) a possible referral of the Family Child Care Home (FCCH) to the Legal Division for possible Administrative Action, or 3) a possible immediate Temporary Suspension Order. Also discussed was the importance of following Title 22 regulations to protect the health and safety of children in care.



A copy of this signed report was given today to Licensees Manuel and Dominica Ayala.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, a deficiency was cited today.

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/02/2021 01:50 PM - It Cannot Be Edited


Created By: Angelica Slaughter On 11/02/2021 at 09:20 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: AYALA, MANUEL & DOMINICA FAMILY CHILD CARE
FACILITY NUMBER: 243909809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2021
Section Cited
CCR
102416.2(b)

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Reporting Requirements - The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
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Licensees stated they will report incidents as required to prevent any future issues. Licensee stated they will watch the CCLD Reporting Requirements video available on the CCLD website.
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This requirement was not met as evidenced by: Licensees failed to report unusual incidents that occurred that could affect children in care. This posses a potential risk to the health, safety and/or personal rights of 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:Diana deLeon
LICENSING EVALUATOR NAME:Angelica Slaughter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2021


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