<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503912279
Report Date: 10/13/2025
Date Signed: 10/13/2025 03:23:20 PM

Document Has Been Signed on 10/13/2025 03:23 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:LOPEZ, ADRIANA FAMILY CHILD CAREFACILITY NUMBER:
503912279
ADMINISTRATOR/
DIRECTOR:		LOPEZ, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 248-7901
CITY:MODESTOSTATE: CAZIP CODE:
95357
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/13/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee Adriana LopezTIME VISIT/
INSPECTION COMPLETED:
03:45 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
Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced Annual/ Random Inspection and was met by Licensee Adriana Lopez. Also present was the licensee’s assistant. Daycare services are provided Monday through Friday, from 7:00 a.m. to 6:00 p.m.

LPA toured the home inside and out, and a census was taken. The current facility sketch was reviewed, confirming that the kitchen, bathroom, living room, and baby room are used for child care and are accessible to children. All other rooms are off-limits and made inaccessible with a baby gate and doorknob spinners.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are stored in a locked area, and none were observed during the inspection. Detergents, cleaning compounds, medications, and other hazardous items are inaccessible.

There are no fireplaces or open-face heaters in the home. A working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation were observed for safety and comfort.

This is a single-level home with no stairs. Safe toys and play equipment were observed. The home has working telephone service, and LPA confirmed the phone number.

The licensee ensures children are supervised at all times and understands that children must not be left in parked vehicles. The backyard outdoor play area is fenced and free of hazards. The facility is operating within the licensed capacity.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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)
Page: 2 of 4
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: LOPEZ, ADRIANA FAMILY CHILD CARE
FACILITY NUMBER: 503912279
VISIT DATE: 10/13/2025
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
26
27
28
29
30
31
32
LPA reviewed a sample of children’s files and found them complete with required emergency information. The licensee’s Mandated Reporter Training is valid through 07/11/2027. The licensee’s pediatric CPR/First Aid certification is valid through December 2026. Records indicate that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

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

Licensee Adriana Lopez 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 an existing clearance or exemption, prior to being present in a licensed Family Child Care Home. A civil penalty of $100.00 per day, for up to 5 days (or up to 30 days for repeat violations), will be assessed for noncompliance.

LPA discussed safe sleep regulations and shared the Child Care Licensing Safe Sleep webpage:
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep.
LPA also advised the licensee to check the U.S. Consumer Product Safety Commission (CPSC) website (https://www.cpsc.gov/) for recalled infant devices and to register all infant equipment to receive recall notifications.

The Incidental Medical Services (IMS) policy was discussed. For more information, see PIN 22-02-CCP. When IMS is provided, a Plan for Providing IMS must be submitted to the Department. ADA information was also provided, including the U.S. Department of Justice ADA Information Line at (800) 514-0301 (voice) / (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/.

Licensee Adriana Lopez was informed about MyChildCarePlan.org, a consumer education website that connects families with child care providers and Resource and Referral Agencies (R&Rs) throughout California.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LOPEZ, ADRIANA FAMILY CHILD CARE
FACILITY NUMBER: 503912279
VISIT DATE: 10/13/2025
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
26
27
28
29
30
31
32
To improve the quality of the inspection process, a survey may be sent to the email address provided. Please complete the survey to share your inspection experience. For questions about the process or CARE tools, email: inspectionprocess@dss.ca.gov. Additional information is available at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

An exit interview was conducted, and the report was reviewed with Licensee Adriana Lopez. During the interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility. LPA verified the RSO profile in FAS.

Per Title 22, Division 12, of the California Code of Regulations, no deficiencies are cited.

Licensee Adriana Lopez was provided appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and is required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4