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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900433
Report Date: 05/20/2022
Date Signed: 05/20/2022 10:13:08 AM


Document Has Been Signed on 05/20/2022 10:13 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:JACKSON,SUZETTEFACILITY NUMBER:
103900433
ADMINISTRATOR:JACKSON,SUZETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 708-8700
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: 3DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Suzette JacksonTIME COMPLETED:
10:30 AM
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On 5/20/2022, Licensing Program Analysts (LPAs) Stephanie Vega-Gonzalez and Nancy Her conducted an unannounced Case Management Plan of Correction inspection. The purpose of the inspection was to review the Plan of Correction for the deficiency cited on 2/22/2022. Today, LPAs met with licensee Suzette Jackson. LPAs toured the facility, and a census was taken of three children in care.

On 2/22/2022, LPA Nancy Her cited licensee a Type B deficiency for not ensuring the inaccessibility of pool. Licensee had two windows and two doors that had direct access to the swimming pool area which posed a potential health, safety or personal rights risk to persons in care. On 5/16/2022 Licensee reported to Community Care Licensing that pool fencing was installed. LPAs inspected swimming pool fencing and observed swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. The deficiency for this violation cited on 2/22/2022 was cleared today.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited today.

An exit interview was conducted with licensee. Notice of Site Visit 9213 will be posted for 30 days.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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