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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902186
Report Date: 10/27/2023
Date Signed: 10/27/2023 01:24:36 PM


Document Has Been Signed on 10/27/2023 01:24 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MARTINEZ, ANA & TERESA FAMILY CHILD CAREFACILITY NUMBER:
153902186
ADMINISTRATOR:MARTINEZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 835-9904
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 3DATE:
10/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ana MartinezTIME COMPLETED:
01:30 PM
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On 10/29/2023, Licensing Program Analysts (LPA) Lady Cabrera conducted an unannounced case management visit to follow-up with incident that was called to Community Care Licensing on 10/03/2022. LPA met with Licensee Ana Martinez for additional information. LPA may return for a follow up visit.


Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited on this report. Licensee Ana Martinez was provided appeal rights.


This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 978-8397
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
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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