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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808851
Report Date: 11/02/2021
Date Signed: 11/02/2021 03:33:44 PM

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:STARTING BLOCKS CHILDREN'S ACADEMYFACILITY NUMBER:
103808851
ADMINISTRATOR:ERMELINDA PEREZFACILITY TYPE:
840
ADDRESS:3315 E SIERRA MADRETELEPHONE:
(559) 227-7036
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:21CENSUS: 12DATE:
11/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Blanca GomezTIME COMPLETED:
03:45 PM
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On 11/02/2021, Licensing Program Analyst (LPA) Nancy Her conducted an unannounced case management inspection. The purpose of this inspection was to address deficiency discovered during an investigative inspection.

During today’s visit, LPA cleared deficiency that was discovered.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are being cited.

Exit interview conducted and report was reviewed with the facility representative Blanca Gomez.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Nancy HerTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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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