503909242-2-11-2025-04-CC-YFIO-DDSUDL-20250211142943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503909242
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:29:51 PM

Document Has Been Signed on 02/11/2025 02:29 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:	BELERIQUE, NANCY FAMILY CHILD CARE		FACILITY NUMBER:	503909242
ADMINISTRATOR/ DIRECTOR:	BELERIQUE, NANCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 480-7370
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	02/11/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	Nancy Belerique		TIME VISIT/ INSPECTION COMPLETED:	10:30 AM

NARRATIVE

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On 02/11/2025 Licensing Program Analyst (LPA), Yesenia Fierro conducted an unannounced annual required inspection and was met by Licensee, Nancy Belerique, also present was Staff #1 (S1). LPA Fierro introduced herself and explained the reason for the visit. All adults who reside or work in the home have a criminal record clearance or exemption. There were no excluded individuals present at this home. Licensee confirmed the home has a working telephone service. LPA Fierro confirmed days and hours of operation are Monday through Friday from 7:45AM-5:00PM.

Licensee stated there is one (1) small dog that the children have access to, Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee stated there are no firearms, ammunition, or bodies of water on the premises.

A current facility sketch was reviewed, and Licensee confirmed that the kitchen, dining room, living room, bathroom, bedroom #1, and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of door spinners, safety gates and locks.

LPA Fierro conducted a census, during today’s inspection there were six (6) children in care, none which were infants, capacity as specified on the license is being maintained. LPA Fierro toured the home inside and outside. This is a single-story home, there are no stairs in this home. The fireplace located in the living room is made inaccessible by a screen and child’s safety gate. Licensee stated that fireplace will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality.

CON'T 809-C

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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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Document Has Been Signed on 02/11/2025 02:29 PM - It Cannot Be Edited

Created By: Yesenia Fierro On 02/11/2025 at 09:55 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: BELERIQUE, NANCY FAMILY CHILD CARE	FACILITY NUMBER: 503909242
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. LPA observed that Staff #1 Mandated Reporter Training expired 1/2024, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	Licensee states that she will have assistant take Mandated Reporter Training and submit proof to CCLD by POC date of 2/14/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Kari McWilliams

LICENSING EVALUATOR NAME:

Yesenia Fierro

LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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: BELERIQUE, NANCY FAMILY CHILD CARE	FACILITY NUMBER: 503909242
	VISIT DATE: 02/11/2025

NARRATIVE

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Licensee stated that all poisons are kept in the garage. LPA did not observe any poisons during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. During today’s inspections LPA observed the home to be in sanitary conditions, areas accessible to children in care are clean and orderly. LPA observed age-appropriate indoor toys, dramatic play equipment, and materials. The outdoor play area in the backyard is fenced and there are no hazards to children present. LPA did not observe a swimming pool or other bodies of water on the premises, and Licensee stated that is no swimming pool or other bodies of water. LPA observed age-appropriate outdoor toys, dramatic play equipment, and materials.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 04/19/2024 and Staff #1 Mandated Reporter Training expired on 1/2024. Licensee’s pediatric CPR/First Aid expires on 11/2025 and Staff #1 pediatric CPR/First Aid expires on 8/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA did not observe any infants in care during inspection. Licensee sated that they are not currently caring for any infants. LPA discussed Safe Sleep Regulations with licensee. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

CON'T 809-C

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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: BELERIQUE, NANCY FAMILY CHILD CARE	FACILITY NUMBER: 503909242
	VISIT DATE: 02/11/2025

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Nancy Belerique, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

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

Exit interview conducted and report was reviewed with the licensee Nancy Belerique.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

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