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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503910662
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:18:59 PM

Document Has Been Signed on 05/09/2025 12:18 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:ALVAJI, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
503910662
ADMINISTRATOR/
DIRECTOR:		ALVAJI, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 620-1061
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
05/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Vickie AlvajiTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 05/09/2025 Licensing Program Analyst (LPA) Pa Kou Vue conducted an unannounced Annual Required Inspection and was met by Assistant. LPA arrived to the Family Childcare Home (FCCH) at 9:30AM, LPA ringed Ring doorbell, knocked on the door and called the listed telephone number with no answer. Around 10:20AM, Assistant opened the front door and LPA gained entrance in the home with the assistance of the local police department. LPA explained to Assistant the purpose of today’s inspection. Assistant stated days and hours of operation are Monday to Friday 7:00AM – 5:00PM. The home has working telephone service and LPA confirmed the phone number is 209-620-1061.

LPA toured the home inside and outside and a census was taken. On today's visit, LPA observed, and Assistant confirmed there are 8 children in care with no other adults present in the licensed home. Assistant stated Licensee has been out of the FCCH home since 05/08/2025 at 5:30PM and will not be returning till 05/10/2025. LPA reviewed the department's regulation with Assistant. Assistant stated she understood. Capacity as specified on the license is being maintained.

LPA reviewed current facility sketch and confirmed that the kitchen, playroom, dining room, living room, (2) bedrooms are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by locking the doors of the off-limits rooms. LPA inspected the restroom and observed the restroom to be clean and sanitized. The sink and toilet are functioning properly within.

Licensee has pets on the premises. Licensee and Assistant area aware of the safety of children around animals. Licensee and Assistant understands her liability and responsibility regarding pets.

There is no swimming pool or other bodies of water on the premises. LPA reminded Assistant that she must maintain supervision of children at all times when engaged in water activities. LPA referred Assistant to PIN 21-16-CCLD: Seasonal Reminder of Water Safety Requirements and Measures.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Pa Kou Vue
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/09/2025 12:18 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 05/09/2025 at 11:33 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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102391(b)
Inspection Authority of the Department
(b) The licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. The Department shall exercise this authority as specified in Health and Safety Code Section 1596.8535(a).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and Assistant interview, the licensee did not comply with the section cited above in LPA gained entrance in FCCH due to police assistance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/10/2025
Plan of Correction
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Licensee and Assistant stated they will review regulation CCR 102391(b) and also submit statements of understanding to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Juvenal Moctezuma
NAME OF LICENSING PROGRAM MANAGER:
Pa Kou Vue
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/09/2025 12:18 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 05/09/2025 at 11:33 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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA records review and Assistant interview, the licensee did not comply with the section cited above in fire drill logs cannot be located which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
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Licensee and Assistant stated they will submit a copy of the fire drill log to LPA via email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Juvenal Moctezuma
NAME OF LICENSING PROGRAM MANAGER:
Pa Kou Vue
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/09/2025 12:18 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 05/09/2025 at 11:33 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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(a)
Operation of A Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and Assistant interview, the licensee did not comply with the section cited above in on the day of the inspection, Assistant was watching 8 daycare children. Assistant stated Licensee has been out of the home since 05/08/2025 at 5:30PM and will not return till 05/10/2025 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
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Licensee and Assistant stated they will review regulation CCR 102417(a) and submit statements of understandings to LPA via email.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA records review and Assistant interview, the licensee did not comply with the section cited above in C1, C2, C4, C5, C6, C7 and C8 are missing at least one or more licensing document (LIC9227, LIC700, LIC627, LIC995A and Immunization Records).which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
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Licensee and Assistant they will submit copies of the requested forms to LPA via email. In addition, LPA provided Assistant a hard copy of LIC811 for references.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Juvenal Moctezuma
NAME OF LICENSING PROGRAM MANAGER:
Pa Kou Vue
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025


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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662
VISIT DATE: 05/09/2025
NARRATIVE
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Assistant stated there are no firearms or ammunitions on the premises. Assistant stated there are no poisons stored on the premises. Assistant stated there is no smoking on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is one fireplace in the home located in the accessible living room and is made inaccessible by a glass door and children’s safety latch and 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.

This is a single level home and there are no stairs. Safe toys and play equipment’s are observed. The outdoor play area in the backyard is fenced and there are no hazards to children present. Assistant was reminded to conduct daily inspections of the outdoor area and on the outdoor play structures and equipment’s for normal wear and tear overtime, to be free of loose, pointed, or sharp edges prior to day-care children accessing outdoor area.

Assistant ensures that children in care are always supervised 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 reviewed a sample of children’s files and observed files were NOT complete with emergency information and all required forms were present and completed as required. Upon LPA records review and Assistant interview, C1, C2, C4, C5, C6, C7 and C8 are missing at least one or more licensing document (LIC9227, LIC700, LIC627, LIC995A and Immunization Records).

Assistant’s Mandated Reporter Training expires on 10/16/2026. Assistant’s pediatric CPR/First Aid certification expires on 01/2026. A review of records indicates that all employees and/or volunteers does NOT have immunization records on file for influenza, pertussis, and measles. All staff files were complete with necessary forms and signed appropriately. Upon LPA records review and Assistant interview, Assistant does not have MMR in file.

Upon LPA records review and Assistant interview, Assistant was not able to provide LPA with the fire drill log upon request. LPA informed Assistant fire drills are to be conducted once every six months and it is best practice to conduct fire drills with the enrollment of a new child. Assistant stated she understood.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Pa Kou Vue
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662
VISIT DATE: 05/09/2025
NARRATIVE
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Assistant 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 Childcare 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.

During the exit interview, the Assistant confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS. Guardian background clearances were verified and discussed with Assistant.

LPA discussed safe sleep regulations with Assistant and discussed the Childcare 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/.

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

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.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Pa Kou Vue
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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: ALVAJI, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 503910662
VISIT DATE: 05/09/2025
NARRATIVE
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Exit interview conducted and report was reviewed with Assistant.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiencies are being cited: (see 809-D for further details).

Licensee was provided appeal rights.

LPA Pa Kou Vue informed Assistant that this report dated 05/09/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Pa Kou Vue informed the Assistant to provide a copy of this licensing report dated 05/09/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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 Assistant.

This report shall be made available to the public upon request. LIC 9213 A Notice of Site Visit is provided and required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Pa Kou Vue
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC809 (FAS) - (06/04)
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