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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910599
Report Date: 10/01/2021
Date Signed: 10/01/2021 01:13:04 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:MEDINA, CLAUDIA FAMILY CHILD CAREFACILITY NUMBER:
103910599
ADMINISTRATOR:MEDINA, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 853-8822
CITY:FRESNOSTATE: CAZIP CODE:
93728
CAPACITY:14CENSUS: 1DATE:
10/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Claudia MedinaTIME COMPLETED:
01:30 PM
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On 10/01/2021, Licensing Program Analyst (LPA) Candis Rodriguez conducted a case management inspection at Licensee's request to add an additional bedroom the license.

LPA observed one child in care during the inspection.

LPA observed bedroom #3. LPA observed age appropriate table and chairs, a play area with age appropriate toys, doll house, and reading/activity area in bedroom #3. LPA observed furniture to be in good repair and braced to the wall as necessary. LPA observed child safety covers on exposed electrical outlets. LPA observed the room to be safe and sanitary as regulations require.

Licensee submitted an updated facility sketch (LIC 999A) along with photographs of bedroom #3 to Community Care Licensing prior to this inspection.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies cited during today's inspection.

Exit interview conducted with Licensee Claudia Medina and a copy of this report was provided. A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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