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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543909537
Report Date: 05/29/2024
Date Signed: 05/29/2024 10:50:32 AM

Document Has Been Signed on 05/29/2024 10:50 AM - 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GOMEZ, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
543909537
ADMINISTRATOR/
DIRECTOR:		GOMEZ, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 786-1660
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Sandra GomezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 05/29/2024, Licensing Program Analyst (LPA) Behatriz Gonzalez conducted an unannounced Case Management inspection. LPA met with Licensee Sandra Gomez. The facility called in an unusual incident on 05/07/2024 regarding licensee who fell with infant in arms. LPA toured the area were the incident occurred and took a census.

On 05/07/2024, licensee called in an Unusual Incident Report. Reporting licensee tripping and falling with infant in her arms. Infant hit face on the floor and had a bloody nose. Parent were notified immediately. Infant was picked up and taken to Pediatrician. Pediatrician said infant was fine and if they saw any changes to report back to the office. Infant was present the next day in care.

LPA interviewed staff and reviewed records. After conducting the case management inspection and interviewing licensee, it was determined that the incident was an isolated incident and not a result of lack of care and supervision. Licensee took appropriate measures to address the child’s injury, following appropriate policies, regulations, and reporting requirements.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

Exit interview conducted and report was reviewed with Licensee Sandra Gomez.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Behatriz Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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