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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910889
Report Date: 09/09/2019
Date Signed: 09/09/2019 10:37:19 AM

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:CENTENO, ERIKA FAMILY CHILD CAREFACILITY NUMBER:
103910889
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
09/09/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Erika CentenoTIME COMPLETED:
10:45 AM
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Licensing Program Analysts (LPAs) Robert Gutierrez & Diane Mercado conducted a Case Management - Other inspection. LPAs met with Licensee Erika Centeno. LPAs toured facility inside and outside and census was taken. The purpose of today's inspection was to discuss licensing forms and answer any questions the licensee may have. Licensees planned hours of operation are Monday – Friday; 4:30 AM - 7:30 PM. First aid/CPR is current and expires 06/16/2020. The rooms/areas accessible to children in care are downstairs bedroom #1 (toy room), dining room (toy area), living room, dining room, kitchen and hallway restroom. The back yard is currently off-limits.

No deficiencies noted during today's visit.

Notice of Site Visit Form to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
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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