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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909288
Report Date: 05/17/2019
Date Signed: 05/17/2019 01:39:43 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:ANDRACA, JACOBA FAMILY CHILD CAREFACILITY NUMBER:
103909288
ADMINISTRATOR:ANDRACA, JACOBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 453-1523
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 7DATE:
05/17/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jacoba Andraca TIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rene Mancinas JR and Jose Penate, conducted an unannounced case management inspection. LPAs met with licensee, Jacoba Andraca, whom is primarily Spanish speaking. The purpose of today's inspection was to inspect an area, previously listed as "off limits", which Jacoba was now requesting to be utilized for day care use. LPA Mancinas inspected the area and deemed it safe for day care use effective today 05/17/2019. LPA Mancinas had Jacoba update facility sketch to reflect changes. LPA Mancinas obtained a copy of updated facility sketch to be filed at CCLD-Fresno Regional Child Care Office.

New area has a fireplace that will not be used during day care hours and is made inaccessible by a metal screening device. Inaccessible bedrooms have safety plastic doorknob spinners, to prevent day care children from accessing.

Per California Code of Regulations Title 22 Division 12 Chapter 3 no deficiency is being cited today. Exit interview conducted with Jacoba. Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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