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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900433
Report Date: 12/22/2020
Date Signed: 12/22/2020 12:11:25 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:JACKSON,SUZETTEFACILITY NUMBER:
103900433
ADMINISTRATOR:JACKSON,SUZETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 708-8700
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: DATE:
12/22/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Suzette JacksonTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Brannon met with licensee, Suzette Jackson. During today’s inspection, LPA observed eight children. LPA did observe two assistants; licensee's daughter and a 14 -year-old. The children were not in the playroom. Per licensee, she has contacted the city to pursue permits for the enclosed playroom.

LPA verified that the pool gate is self-latching. LPA provided licensee with a Letter of Deficiency Citations Cleared. LPA instructed licensee to post the letter on her parent board.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today’s inspection. Exit interview conducted with licensee, Suzette Jackson. A copy of this report needs to be placed in facility file for public review. A Notice of Site Visit was posted on parent board for 30 days.

To order forms, etc. visit our website at www.ccld.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020
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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