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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 545620287
Report Date: 03/26/2024
Date Signed: 03/26/2024 10:30:05 AM

Document Has Been Signed on 03/26/2024 10:30 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:PEREZ, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
545620287
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/26/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Martha PerezTIME COMPLETED:
10:45 AM
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On 3/26/2024, an unannounced case management inspection was conducted today by Licensing Program Analyst (LPA), Claribel Soto. LPA met with licensee, Martha Perez. Purpose of today's inspection is to conduct a case management visit and a 90 Day follow-up on initial pre-licensing visit that took place on 11/15/2023. LPA inspected the backyard and is approved to be used by the daycare children. This is a single story, three bedrooms and two bath home and children will have access to the living room, dining room, one bedroom and hallway bathroom. Off-limits rooms are made inaccessible by use of doorknob spinners. Safe toys and cabinets without unsafe items, and a clean and orderly home are all observed. There is no fireplace in the home. The outdoor play area in the backyard is fenced and there are no hazards to children present. There are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Operable fire extinguisher, smoke alarm, carbon monoxide and first aid kit are in place. There are no "bodies of water" or firearms in this home. There is a working telephone and number was verified. There are five dogs. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

Licensee’s CPR and first aid training are current with an expiration date of 10/2/2024. Licensee’s Mandated Reporter Training was completed on 6/23/2023. LPA discussed with licensee, fire drills are required to be conducted and documented at least every 6 months. Licensee will be providing parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Background clearances are discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared.

Licensee states she will operate her day care Monday through Sunday from 5:00 AM to 6:00pm.

Continued on 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Claribel Soto
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: PEREZ, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 545620287
VISIT DATE: 03/26/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

LPA & licensee discussed the Community Care Licensing Website, Lead Safety, and Mandated Reporter Training: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE INSPECTION FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Claribel Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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