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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911360
Report Date: 04/15/2021
Date Signed: 04/15/2021 04:27:26 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:FARFAN, ANNA FAMILY CHILD CAREFACILITY NUMBER:
103911360
ADMINISTRATOR:FARFAN, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 840-2400
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 0DATE:
04/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Anna FarfanTIME COMPLETED:
04:45 PM
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A third announced pre-licensing inspection was conducted today by Licensing Program Analyst (LPA), Norma Lomeli. Met with Applicant, Anna Farfan. Applicant, her two adult daughters, her son in law and two minor children reside in the home.

The purpose of today's inspection is to verify that the following correction requested was made. LPA observed the following correction during today's inspection:
  • LPA observed that applicant installed self latching devices on both gates that are not more than six inches from the top of the gate. The black rod iron fence has two gates that are self closing/self latching and swing away from the pool. During today's inspection, LPA verified that the pool fence meets Title 22 Regulations.

Licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended effective April 19, 2021.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
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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