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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
103908972
Report Date:
01/31/2020
Date Signed:
01/31/2020 01:01:23 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:
PELAGIO, XOCHITL FAMILY CHILD CARE
FACILITY NUMBER:
103908972
ADMINISTRATOR:
PELAGIO, XOCHITL
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(559) 210-2174
CITY:
HURON
STATE:
CA
ZIP CODE:
93234
CAPACITY:
14
CENSUS:
1
DATE:
01/31/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Xochitl Pelagio
TIME COMPLETED:
01:15 PM
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On 01/31/2020 an unannounced Case Management inspection was conducted today by Licensing Program Analyst (LPA) Robert Gutierrez. LPA met with Licensee Xochitl Pelagio. The purpose of todays inspection was to discuss inactive status with licensee. Speaking with the licensee she stated she would like to be placed on inactive status until 02/01/2021. Licensee understands she must continue to pay her annual fees while on inactive status. In addition licensee understands that if she were to operate prior to 02/02/2021 she must contact the Fresno Regional office.
This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is provided and required to be posted for 30 days.
SUPERVISOR'S NAME:
Susie Fanning
TELEPHONE:
(559) 650-7890
LICENSING EVALUATOR NAME:
Robert Gutierrez
TELEPHONE:
559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE:
01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/31/2020
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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