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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503912104
Report Date: 06/04/2025
Date Signed: 06/04/2025 03:55:48 PM

Document Has Been Signed on 06/04/2025 03:55 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:CABADAS. SAMANTHA FAMILY CHILD CAREFACILITY NUMBER:
503912104
ADMINISTRATOR/
DIRECTOR:		CABADAS, SAMANTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 502-5208
CITY:KEYESSTATE: CAZIP CODE:
95328
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
06/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Licensee Samantha CabadasTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced annual/random inspection and was met by Licensee Samantha Cabadas. Also present during the inspection was the licensee’s husband. The facility provides daycare services Monday through Friday from 6:00 a.m. to 6:00 p.m.

LPA toured the home both inside and outside and conducted a census of children in care. A review of the current facility sketch confirmed that the hallway bathroom, living room, and dining area are designated for child care and are accessible to children. All other areas of the home are off-limits and were observed to be made inaccessible through the use of baby gates and doorknob covers.

Licensee Samantha Cabadas stated that there are three dogs on the premises; however, they are kept outside and do not come into contact with children while care is being provided. LPA reminded the licensee that in the event of any pet-related injury, she would be responsible for her pets' actions.

There is no swimming pool or other bodies of water on the premises. LPA discussed new pool safety requirements under Assembly Bill 2866, effective January 1, 2025, and informed the licensee that Provider Information Notice (PIN) 25-01-CCP was issued on January 6, 2025, outlining the new requirements.

The licensee stated there are no firearms or ammunition in the home. All poisons are stored in locked areas, and none were observed during the inspection. Detergents, cleaning compounds, medications, and other hazardous items were observed to be stored in a manner that makes them inaccessible to children.

The home does not contain any fireplaces or open-face heaters. A working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation were observed, ensuring the safety and comfort of children in care. (Continued on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025
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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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: CABADAS. SAMANTHA FAMILY CHILD CARE
FACILITY NUMBER: 503912104
VISIT DATE: 06/04/2025
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This is a single-level home with no stairs. Safe toys and age-appropriate play equipment were observed. The home has working telephone service, and LPA confirmed the facility’s phone number is (209) 502-5208.

The licensee ensures that children are supervised at all times and is aware that children shall not be left unattended in parked vehicles. The backyard outdoor play area is currently inaccessible. LPA informed the licensee that if she wishes to use the area, it must first be inspected and approved by Child Care Licensing, and the facility sketch must be updated accordingly.

LPA reviewed a sample of children’s records and confirmed that emergency information was complete and current. The licensee’s Mandated Reporter Training is valid through June 20, 2025. Her Pediatric CPR/First Aid certification is current and expires in April 2026. A review of staff records showed that all required immunizations for influenza, pertussis, and measles are on file for employees and volunteers.

LPA provided information about the Community Care Licensing Division (CCLD) website at www.ccld.ca.gov, which offers access to forms, regulations, Provider Information Notices (PINs), and Quarterly Updates. LPA also reviewed Reporting Requirements pursuant to Title 22, Section 102416.2.

The licensee was reminded that all adults aged 18 and over living in or working at 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, prior to being present in the home. Failure to comply may result in a civil penalty of $100 per day for up to 5 days, or for up to 30 days for repeat violations.

At the time of the inspection, Licensee Samantha Cabadas reported that she is not currently providing care for infants aged 0 to 24 months. However, LPA discussed Safe Sleep regulations in anticipation of future infant care and provided information on the Child Care Licensing Safe Sleep webpage: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep. LPA also emphasized the importance of checking the U.S. Consumer Product Safety Commission (CPSC) website for recalled infant products and recommended registering infant devices to receive safety alerts: https://www.cpsc.gov. (Continued on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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: CABADAS. SAMANTHA FAMILY CHILD CARE
FACILITY NUMBER: 503912104
VISIT DATE: 06/04/2025
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Incidental Medical Services (IMS) policy was reviewed. For more information, licensee was referred to PIN 22-02-CCP. LPA advised that a Plan for Providing IMS must be submitted to the Department if IMS will be provided.

Information regarding the Americans with Disabilities Act (ADA) was provided, including the U.S. Department of Justice ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY), and the publication Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPA also informed the licensee of the www.MyChildCarePlan.org website, a consumer education platform that connects families with child care providers and local Resource and Referral Agencies across California.

An exit interview was conducted, and the report was reviewed with Licensee Samantha Cabadas. During the interview, the licensee confirmed that no Registered Sex Offenders reside at the facility, and LPA verified the RSO status in the Field Automation System (FAS).

Pursuant to Title 22, Division 12 of the California Code of Regulations, no deficiencies were cited during the inspection.

Licensee Samantha Cabadas was provided a copy of the Appeal Rights.

This report shall be made available to the public upon request. LIC 9213, Notice of Site Visit, was issued and must be posted for 30 days. (End of Report)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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