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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103904987
Report Date: 09/03/2024
Date Signed: 09/03/2024 12:59:50 PM


Document Has Been Signed on 09/03/2024 12:59 PM - 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:PEREZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
103904987
ADMINISTRATOR:PEREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 646-9005
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY:14CENSUS: 0DATE:
09/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Maria PerezTIME COMPLETED:
01:20 PM
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On 09/03/2024, Licensing Program Analysts (LPA), Jose Penate conducted an unannounced Case Management inspection today with Licensee, Maria Perez. Licensee stated she has not been watching day-care children since July 2024. Licensee stated she is wanting to place her license on Inactive Status. During today's inspection, licensee filled out inactive form LIC 9211. Licensee has been instructed to follow the conditions listed on the inactive form.

Per California Code of Regulations Title 22, no deficiency cited during today's inspection.

Exit interview conducted with the licensee, Maria Perez.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

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

SUPERVISOR'S NAME: Gloria ReyesTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024
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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