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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900470
Report Date: 01/16/2020
Date Signed: 01/16/2020 03:36:08 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:BARBIN,JOSEPHINFACILITY NUMBER:
103900470
ADMINISTRATOR:BARBIN,JOSEPHINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 494-0483
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:14CENSUS: 3DATE:
01/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Josephin BarbinTIME COMPLETED:
03:30 PM
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On this date, an unannounced Case Management Inspection was conducted by Licensing Program Analyst (LPA) Diane Mercado. LPA met with Licensee Josephin Barbin and census was taken. The purpose of todays inspection was to assist Licensee with Mandated Reporter Training AB 1207. During 01/09/20 annual inspection licensee was cited (1596.8662(b)(1) for not having Mandated Reporter Training Completed AB 1207 for her self or staff.

Licensee contacted LPA Mercado to inform her of technical issues with online training. Licensee was not able to move onto second section part of training. Licensee requested if LPA could assist her with the issue. LPA was able to assist Licensee with first section of training and Licensee is now able to move on to second section.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today. LIC 9213 Notice of Site of Visit Form is required to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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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