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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103900956
Report Date: 01/11/2023
Date Signed: 01/11/2023 09:59:53 AM


Document Has Been Signed on 01/11/2023 09:59 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ALVAREZ,AMALIAFACILITY NUMBER:
103900956
ADMINISTRATOR:ALVAREZ,AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 399-3046
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:14CENSUS: 5DATE:
01/11/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Amalia AlvarezTIME COMPLETED:
10:15 AM
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On 1/11/23 Licensing Program Analyst, (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Licensee, Amalia Alvarez and toured the home. A census was taken. The licensee's daughter/assistant, Carol Denbok was also on the telephone and helped interpret.

The purpose of the inspection is to clear deficiencies that were previously cited on 12/12/22. LPA reviewed children's files. Children's files were complete with all required documents/ forms. Infant files, showed proof of Individual Sleep Plans and 15 minute checks. Upon staff file review, the licensee and her assistants files were complete.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. Exit interview was conducted with Amalia Alvarez and Carol Denbok via telephone. Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiency was found during today’s inspection.

A copy of this report and LIC 9213 Notice of Site Inspection were provided to the licensee, Amalia Alvarez. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
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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