503912207-2-27-2024-04-CC-JYAZ-D2UU4C-20240227141454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503912207
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:15:04 PM

Document Has Been Signed on 02/27/2024 02:15 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:	GOMEZ, CLARIBEL FAMILY CHILD CARE		FACILITY NUMBER:	503912207
ADMINISTRATOR:	GOMEZ, CLARIBEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 420-8552
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/27/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Claribel Gomez		TIME COMPLETED:	02:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/27/2024, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Claribel Gomez for a pre-licensing/change of location inspection. Applicant, her husband, and five minor children reside in the home. Background clearances are discussed and LIS 531/Roster Report were signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on November 29, 2023. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: · Fire clearance was received on January 12, 2024. Fire pull alarm is located on the home’s living room wall. · On this date, 10/31/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. · This is a two story four bedroom, two and a half bathroom home and upstairs area will be off-limits to the day-care children. LPA did not observe a gate at the bottom of the stairs. Care and supervision will be provided in the living room, dining room, family room, kitchen, and downstairs hallway bathroom. There is an electric fireplace in the family room that applicant states will not be used during day-care hours. (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, CLARIBEL FAMILY CHILD CARE	FACILITY NUMBER: 503912207
	VISIT DATE: 02/27/2024

NARRATIVE

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· Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on August 13, 2024.
· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on February 1, 2024.
· Applicant completed the Mandated Reporter Training on November 6, 2023.
· SB 792 immunizations verified and on file.
· Applicant provided proof of control of property.
· In the living room, LPA observed children size furniture, table, and chairs, wooden cubbies for storage, and safe games, toys, and books for the children. Children will nap on cots/mats, infants will nap in play yards in the living room. Applicant understands she is to supervise children at all times.
· Fenced backyard has cement and sodded area for the children. There is a patio porch for shade. LPA observed safe toys for the children.
· Facility has 1A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
· Knives and medications are stored in top kitchen cabinets. Cleaning compounds are stored in a storage closet in the downstairs laundry room.
· There are no bodies of water in the home or premises.
· Applicant states there are no pets in the home or on the premises.
· Applicant states there are no firearms or ammunition in the home or premises.
· Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
· Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
· Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
(CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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: GOMEZ, CLARIBEL FAMILY CHILD CARE	FACILITY NUMBER: 503912207
	VISIT DATE: 02/27/2024

NARRATIVE

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· Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
· Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information and-resources/safe-sleep, as an additional resource. LPA also informed applicant 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. LPA provided applicant with Individual Infant Sleeping Plan and Safe Sleep handout.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. (CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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: GOMEZ, CLARIBEL FAMILY CHILD CARE	FACILITY NUMBER: 503912207
	VISIT DATE: 02/27/2024

NARRATIVE

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant was advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant was informed of the MyChildCarePlan.org site, 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. Applicant states she will operate her day care Monday through Friday from 5:00 am to 6:00pm and as arranged. No overnight care will be provided.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities,
providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly
Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
· Applicant will barricade the bottom of the staircase with a child proof safety gate.
· Applicant will obtain a 2A10BC or bigger fire extinguisher.
· Applicant will make the downstairs laundry room inaccessible to day care children.
· Applicant will reinforce two sections of the wooden fence located in the backyard.

Pending verification of corrections of the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended. Exit interview conducted and report was reviewed with applicant.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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