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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911607
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:37:56 PM

Document Has Been Signed on 05/29/2024 12:37 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HOLGUIN, NAOMI FAMILY CHILD CAREFACILITY NUMBER:
543911607
ADMINISTRATOR/
DIRECTOR:		HOLGUIN, NAOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 747-4917
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Naomi HolguinTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On May 29, 2024 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management inspection and met with Licensee Naomi Holguin. LPA McWilliams toured the facility and a cenusus was taken.

LPA McWilliams informed Licensee the purpose of todays inspection was due to her over due fees. LPA McWilliams informed Licensee that a letter was sent regarding her over due fees on 10/10/2023, a second letter was sent on 05/02/2024 and a phone call with a voicemail was left on 05/15/2024. Based upon the Departments multiple attempts and Licensee's failure to pay her fees a type B citation was cited. LPA McWilliams informed Licensee that failure to pay her fees on time could result in a forfeiture of her license. LPA McWilliams provided Licensee with a copy of the regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited, please see additional 809-D for further information.

Exit interview conducted and report was reviewed with licensee Naomi Holguin. 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: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
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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Document Has Been Signed on 05/29/2024 12:37 PM - It Cannot Be Edited


Created By: Kari McWilliams On 05/29/2024 at 11:57 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: HOLGUIN, NAOMI FAMILY CHILD CARE
FACILITY NUMBER: 543911607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2024
Section Cited
CCR
102384(e)

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102384 Licensing Fees
(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license.”
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Licensee stated that she will pay her fees on line. Licensee paid fees during LPA's inspection and sent LPA a copy of the receipt via text message.
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This requirement was not met be evidence of licensees fees were not paid and were 121 days overdue.
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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:Luisa Gavoutian
LICENSING EVALUATOR NAME:Kari McWilliams
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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