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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911607
Report Date: 02/20/2025
Date Signed: 02/20/2025 05:07:40 PM

Document Has Been Signed on 02/20/2025 05:07 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 RO, 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: 9DATE:
02/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Naomi HolguinTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On 02/20/2025, Licensing Program Analyst (LPA) Christopher Burnias arrived for a complaint inspection and found the facility was over capacity and out of ratio. Licensee called Assistant 1 (A1) to come assist in the home in order to bring the facility into compliance.

A review of A1's records showed that A1 did not have a Mandated Reporter Training Certificate on file or current First Aid/CPR certifications. LPA verified that A1 did have a criminal record clearance on file. A1 was unable to provide proof of completed TB test, immunization records for Measles, Pertussis, and influenza, signed LIC 9052 Notice of Employee Rights, and signed LIC 9108 Statement Acknowledging Requirement to Report Child Abuse.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiency is being cited: (see next page).

Licensee Naomi Holguin was provided appeal rights along with a copy of form LIC 126 Entrance Checklist - Family Child Care Homes showing all documents required for assistants/staff.

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: Christopher Burnias
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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 02/20/2025 05:07 PM - It Cannot Be Edited


Created By: Christopher Burnias On 02/20/2025 at 04:21 PM
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: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
102416.1(a)

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102416.1(a) Personnel records shall be maintained on each employee...
This requirement was not met as evidenced by:
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Licensee is to provide the Department a copy of immunization records, First Aid/CPR and Mandated Reporter training for all assistants.
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Based LPA observation, Licensee did not have records for assistants to show proof of immunizations or First Aid/CPR, Mandated Reporter training. This poses a potential risk to the health, safety, and personal rights of children in care.
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Licensee is to also review regulation 102416.1(a) and provide the Department a written statement indicating they read and understood the regulation and will ensure compliance.

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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:Christopher Burnias
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
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