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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153904504
Report Date: 08/23/2021
Date Signed: 08/23/2021 12:29:03 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:FERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
153904504
ADMINISTRATOR:FERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 664-8973
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:14CENSUS: 4DATE:
08/23/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Maria FernandezTIME COMPLETED:
01:00 PM
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On 8/23/21 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Licensee, Maria Fernandez and toured the home. A census was taken.

The purpose of the inspection is to check the latches on the kitchen drawers and cabinets, that contain hazardous items, that were not latching correctly per deficiency cited on 7/22/21. LPA observed all of the latches in the kitchen to be latching correctly.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. An exit interview was conducted with Maria Fernandez. Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiency was cited during today’s inspection.

A copy of this report along with appeal rights and LIC 9213 Notice of Site Inspection were provided to the licensee, Maria Fernandez. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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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