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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503903750
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:32:36 PM

Document Has Been Signed on 11/08/2023 01:32 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:GUEVARA, OFELIA FAMILY CHILD CAREFACILITY NUMBER:
503903750
ADMINISTRATOR:GUEVARA, OFELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 894-7863
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Ofelia GuevaraTIME COMPLETED:
01:56 PM
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On 11/8/2023 Licensing Program Analyst (LPA) Anita Tristan conducted an unannounced inspection regarding an unrelated matter. LPA met with Licensee, Ofelia Guevara. LPA Tristan explained the reason of the inspection and toured the facility, inside and outside. Also present was staff# 1. LPA Tristan observed 4 children playing in the front day care area, 3 children playing in the living room area, one child sitting in the kitchen. Each was blocked off by either the use of a play yard or baby gate. LPA also observed a 7-month-old infant asleep in bedroom next to the kitchen with door closed.

Upon further investigation of the bedroom LPA observed 7-month-old infant asleep and restrained in a bouncer, that was placed inside of a crib in the back corner of the room. Infant was swaddled, had a pacifier clipped to clothing, and was covered from head to toe with a white wool blanket. Licensee stated that she uses the room to put the infant asleep. Licensee stated that the infant was not in the room. Upon further investigation of the bedroom LPA Tristan saw the infants foot sticking out from underneath the blankets. LPA informed licensee of Safe Sleep Regulations and licensee removed infant from crib and un-swaddled the infant.

During the exit interview licensee stated that she was unaware that the infant was in the because licensee was caring for the older children and staff #1 was caring for the smaller children. Licensee did not know that the assistant placed the baby in the nap room.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page).
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GUEVARA, OFELIA FAMILY CHILD CARE
FACILITY NUMBER: 503903750
VISIT DATE: 11/08/2023
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Exit interview conducted with Licensee, Ofelia Guevara. A copy of this report and Appeal Rights were provided and discussed with Licensee Ofelia Guevara.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee Ofelia Guevara.

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.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/08/2023 01:32 PM - It Cannot Be Edited


Created By: Anita Tristan On 11/08/2023 at 12:42 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: GUEVARA, OFELIA FAMILY CHILD CARE
FACILITY NUMBER: 503903750

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
102425

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(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier. This requirement was not met as evidenced by: Licensee failed to follow safe sleep regulation
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Licensee agreed that she will watch the informational videos and read information on Safe Sleep available at www.ccld.ca.gov under the section of Safe Sleep. Licensee will provide a written statement in regard to completion of watching the video and best practices moving forward. Proof of written statement is to be submitted to Community Care Licensing (CCL)-Fresno by 11/09/2023.
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LPA observed closed bedroom door with sleeping swaddled and restrained infant in bouncer placed in crib with loose articles and objects, pacifier clipped to clothing and a blanket covering infants head.
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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:Anita Tristan
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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