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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543909731
Report Date: 09/17/2021
Date Signed: 09/17/2021 11:43:52 AM

Document Has Been Signed on 09/17/2021 11:43 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SANCHEZ, RAQUEL FAMILY CHILD CAREFACILITY NUMBER:
543909731
ADMINISTRATOR:SANCHEZ, RAQUELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 602-0305
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Raquel SanchezTIME COMPLETED:
10:00 AM
NARRATIVE
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On 09/17/2021 Licensing Program Analysts (LPAs) Nancy Her and Jeovanna Yanez arrived to facility to conduct an unannounced case management visit. LPAs met with Licensee Raquel Sanchez who is Spanish Speaking. LPA Jeovanna Yanez assisted with interpretation.

Upon arrival at facility LPAs observed infant number one, 15 month old, asleep in the play pen. Child number one was asleep until 10:00 am. LPAs observed that Licensee nor staff member did not check on sleeping infant during course of visit. LPAs reviewed safe sleep log. The last date of entry on safe sleep log is 9/15/2021 however there aren't any times notated.

LPAs observed infant number two, 5 month old, awake and laying in a crib. LPAs inquired about how long infant has been awake. Assistant Ricardo Mayorga stated that the infant hasn't been asleep since the infant arrived.

Per California Code of Regulations, Title 22, Division 12, Chapter 3 the following deficiency is being cited on the attached LIC 9099D.

Exit interview conducted and report was reviewed with Licensee Raquel Sanchez.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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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Document Has Been Signed on 09/17/2021 11:43 AM - It Cannot Be Edited


Created By: Nancy Her On 09/17/2021 at 11:05 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: SANCHEZ, RAQUEL FAMILY CHILD CARE
FACILITY NUMBER: 543909731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/04/2021
Section Cited
CCR
102425(j)

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The provider shall supervise infants while they are sleeping and adhere to the following requirements: (1) The provider shall physically check on sleeping infants every 15 minutes...(D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
3. Time of each 15-minute check.
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Licensee will physically check on sleeping infants every 15 minutes and notate every 15 minute check on safe sleep log. Licensee will
submit two weeks of sign in/out sheets for infants as well as safe sleep log for each infant to Fresno Community Care Licensing by 10/04/2021.
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 This requirement was not met as evidenced by LPAs observations and record review. LPAs observed Licensee and staff member did not check on sleeping infant during duration of today's visit. Safe sleep log also does not have time of each 15-minute check for today.
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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.
SUPERVISOR'S NAME:Duane Matsubara
LICENSING EVALUATOR NAME:Nancy Her
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021


LIC809 (FAS) - (06/04)
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