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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153806122
Report Date: 02/07/2022
Date Signed: 02/07/2022 02:47:18 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:URENA, LUZ FAMILY CHILD CAREFACILITY NUMBER:
153806122
ADMINISTRATOR:URENA, LUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 364-8888
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 5DATE:
02/07/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Luz Urena TIME COMPLETED:
03:00 PM
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On this date, 02/07/22 an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Araceli Gibson. Licensee had notified LPA deficiencies were ready to be cleared. Licensee had five children in care on today’s inspection. LPA met with Licensee to review the POC's associated to deficiencies cited on 01/05/22. Today, LPA verified the following:

· Licensee maintains kitchen counters, living room, bedroom 1, bedroom 2 and outdoor playing area clean and free of clutter.
· Licensee had staff records completed. LPA Gibson verified LIC 508, driver’s license, employee rights and child abuse statement for assistant.
· LPA reviewed seven children’s record, which were verified and complete.

LPA cleared deficiencies on this date 02/07/22 and provided Licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

Per California Code of Regulations Title 22, Division 12, Chapter 3 no deficiency cited during today's visit. Exit interview conducted with the Licensee.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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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