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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153903787
Report Date: 10/30/2019
Date Signed: 10/30/2019 12:49:58 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:TRUSTY, STACI FAMILY CHILD CAREFACILITY NUMBER:
153903787
ADMINISTRATOR:TRUSTY, STACIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 589-0602
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:14CENSUS: 9DATE:
10/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Staci Trusty - Licensee TIME COMPLETED:
01:00 PM
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An unannounced Case Management inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Staci Trusty. LPA toured the facility. No children were present on this date.

LPA Thompson conducted an unannounced Annual Random inspection on 10/22/19; due to computer issues, LPA Thompson was unable to provide Licensee with a copy of the LIC809, LIC809-C, LIC809-D, and LIC809-D associated to the inspection. On this date, LPA provided Licensee with all related reports.

Additionally, the licensee provided LPA Thompson with a plan addressing the methods she will utilize going forward to ensure compliance with ratio and capacity requirements, thereby clearing the deficiency cited on 10/22/19.

LPA provided the licensee with a "Letter of Deficiency Citations Cleared." Letter must be filed in facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies cited on this report.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019
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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