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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910777
Report Date: 10/14/2021
Date Signed: 10/14/2021 05:04:07 PM

Document Has Been Signed on 10/14/2021 05:04 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SANTOS-PACHECO, ANA FAMILY CHILD CAREFACILITY NUMBER:
203910777
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
10/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Ana Santos-PachecoTIME COMPLETED:
05:15 PM
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On October 14, 2021, Licensing Program Analyst (LPA), Norma Lomeli conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection was licensee, her husband who will also be her assistant, her three minor children and four day care children. Licensee, her husband and four minor children reside in the home. Verified licensee CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on February 4, 2023. Licensee’s Assistant, Wilfrido Mendoza completed the training through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on August 19, 2023. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on September 22, 2021.

A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed:
  • Fire clearance was received on September 28, 2021. Fire alarm is located in the home’s hallway wall.
  • LPA observed in bedroom #4 children size furniture, safe toys and books for the children. Also observed an infant swing and a stroller. There is a parent’s board that is located on the right hand side wall of the home’s entry way.
  • Licensee states she does not have weapons, firearms, ammunition or poisons in the home.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SANTOS-PACHECO, ANA FAMILY CHILD CARE
FACILITY NUMBER: 203910777
VISIT DATE: 10/14/2021
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Licensee is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
  • Licensee will provide proof of current Mandated Training Certification for assistant.

Pending verification of corrections of the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SANTOS-PACHECO, ANA FAMILY CHILD CARE
FACILITY NUMBER: 203910777
VISIT DATE: 10/14/2021
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  • Facility has 2A10BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place.
  • Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • Licensee is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Licensee states the home is smoke-free.
  • Licensee states she will be transporting day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Required items are posted in the Child Care Home where parents may easily view.
  • During visit capacity worksheet was provided and discussed.
  • Licensee completed the Mandated Reporter Training on September 24, 2020. Licensee will provide proof of assistant’s certification.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.

LPA & licensee discussed the Community Care Licensing website: 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.

Licensee states her hours of operation are Monday through Saturday from 4:00 AM to 5:30 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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