543911651-12-19-2023-57-CC-CSOO-CYNQUH-20231219112848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911651
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:28:58 AM

Document Has Been Signed on 12/19/2023 11:28 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, BERTHA FAMILY CHILD CARE		FACILITY NUMBER:	543911651
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	12/19/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Bertha Gomez		TIME COMPLETED:	11:45 AM

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On 12/19/2023 Licensing Program Analyst (LPA), Claribel Soto conducted an unannounced Annual Random Inspection and was met by licensee, Bertha Gomez. Days and hours of operation are Monday through Sunday 24 hours a day with no continuous care over 23 ½ hours. The home has working telephone service and LPA confirmed the phone number is (559) 467-9794.

LPA toured the home inside and outside and a census was taken. LPA reviewed current facility sketch and confirmed that the kitchen, dining room, bathroom, and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by doorknob spinners.

This is a single level home and there are no stairs. Safe toys and play equipment are observed. There is an open face heaters in the home, but is not in working condition and is covered. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. All firearms and ammunition are stored and locked separately. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The outdoor play area in the front yard is fenced and there are no hazards to children present. There are two cats. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. There is no swimming pool or other bodies of water on the premises.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed 3 of 5 files were incomplete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 10/26/2023. Licensee’s pediatric CPR/First Aid certification expires on 2/4/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

Continued on 809-C

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Claribel Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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

FACILITY NAME: GOMEZ, BERTHA FAMILY CHILD CARE	FACILITY NUMBER: 543911651
	VISIT DATE: 12/19/2023

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

Licensee 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 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.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed licensee 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Claribel Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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

FACILITY NAME: GOMEZ, BERTHA FAMILY CHILD CARE	FACILITY NUMBER: 543911651
	VISIT DATE: 12/19/2023

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Licensee was provided appeal rights.

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

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Claribel Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

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