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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808815
Report Date: 11/08/2022
Date Signed: 11/08/2022 11:56:00 AM


Document Has Been Signed on 11/08/2022 11:56 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ST. AGNES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
103808815
ADMINISTRATOR:PRICE, MARYELLENFACILITY TYPE:
830
ADDRESS:1255 E. HERNDON AVE.TELEPHONE:
(559) 450-3545
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:40CENSUS: 34DATE:
11/08/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Amanda TullerTIME COMPLETED:
12:15 PM
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On November 8, 2022, Licensing Program Analyst (LPA) Brannon met with director, Amanda Tuller. During today's inspection, LPA toured facility, reviewed staff files, received copies of documents and interviewed staff.
Per Title 22, Division 12, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with director, Amanda Tuller .

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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