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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908435
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:01:55 PM


Document Has Been Signed on 05/23/2023 02:01 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CASTILLO, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
103908435
ADMINISTRATOR:CASTILLO, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 453-7055
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: DATE:
05/23/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Guadalupe CastilloTIME COMPLETED:
02:00 PM
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On 5/23/2023, Regional Manager R Varela, Licensing Program Manager C Brannon and LPA Denisia Jimenez met with licensee, Guadalupe Castillo.

The purpose of today's visit is to deliver the following documents:
Accusation
Notice to Respondents
Statement to Respondents
Request for Discovery
Notice of Defense

Forms reviewed with licensee, and licensee is to submit Notice of Defense within 15 days from today's visit.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Denisia JimenezTELEPHONE: (559) 767-0718
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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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