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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103810087
Report Date: 10/22/2019
Date Signed: 10/22/2019 08:28:37 AM

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:TINY TOWNFACILITY NUMBER:
103810087
ADMINISTRATOR:DIAZ, RUBENFACILITY TYPE:
830
ADDRESS:601 THIRD STTELEPHONE:
(559) 646-2731
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY:12CENSUS: 0DATE:
10/22/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Rebecca CamargoTIME COMPLETED:
09:00 AM
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LPA Brannon met with Site Supervisor/Teacher, Rebecca Camargo. The licensee is Parlier Unified School District. The center is located at Brletic Elementary School.

Fire clearance received for 8 infants.

Prior visit conducted on 10/8/19. During prior visit, there were 9 items that needed to be corrected. During today's visit, LPA verified that the 9 items were corrected.

Pending a final file review, a recommendation will be made to license the above facility for a capacity of 8 infants. Licensee shall update LIC 500, and LIC 610.

To order forms, etc. visit our website at www.ccld.ca.gov .
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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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