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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909421
Report Date: 01/13/2023
Date Signed: 01/13/2023 03:41:44 PM


Document Has Been Signed on 01/13/2023 03:41 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:VALENZUELA, JAMIE FAMILY CHILD CAREFACILITY NUMBER:
103909421
ADMINISTRATOR:VALENZUELA, JAMIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 473-3685
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: 12DATE:
01/13/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jamie ValenzuelaTIME COMPLETED:
04:00 PM
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On 1/13/2023, Regional Manager R Varela and Licensing Program Manager C Brannon met with licensee, Jaime Valenzuelza.

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
Declaration of Service

Forms reviewed with licensee, and licensee is to submit Notice of Defense within 15 days from today's visit.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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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