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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100405600
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:22:08 PM


Document Has Been Signed on 03/30/2022 03:22 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:KIDS KARE SIERRA VISTAFACILITY NUMBER:
100405600
ADMINISTRATOR:VARGAS, KRISTINA WOODYFACILITY TYPE:
840
ADDRESS:1321 HOBLITTTELEPHONE:
(559) 299-0403
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:95CENSUS: 77DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kristina VargasTIME COMPLETED:
04:00 PM
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On 03/30/2022, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced Case Management inspection at facility to amend a complaint inspection report. LPA met with Director Kristina Vargas, explained purpose of inspection, toured the facility and took a census.

LPA returned on today's date to amend the complaint inspection report and obtain signatures. Due to information received and decision by Regional Office management, the original report dated 10/18/2021 was amended. LPA explained the amended report to Director and left a copy of the amended report with facility.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency was cited during today's inspection.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2022
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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