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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908554
Report Date: 07/08/2019
Date Signed: 07/08/2019 12:18:23 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:SAMAYOA, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
153908554
ADMINISTRATOR:SAMAYOA, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 379-5921
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:14CENSUS: 9DATE:
07/08/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Sandra SamayoaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jose Penate conducted a plan of correction inspection. LPA met with Licensee, Sandra Samayoa also present was Assistant. The purpose of the inspection is to clear deficiencies. Licensee presented CPR/First Aid cards, they are current and expire on 06/23/2021 and assistant CPR/First Aid will expire on 06/23/2021.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE INSPECTION FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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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