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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909642
Report Date: 01/06/2022
Date Signed: 01/06/2022 10:55:15 AM

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:VIVEROS, EDELMIRA FAMILY CHILD CAREFACILITY NUMBER:
153909642
ADMINISTRATOR:VIVEROS, EDELMIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 348-9951
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 2DATE:
01/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Edelmira ViverosTIME COMPLETED:
11:00 AM
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A case management inspection was conducted Thursday, 01/06/22 by Licensing Program Analysts, (LPA) Araceli Gibson. LPA met with Licensee, Edelmira Viveros. The purpose of the case management inspection was to assist Licensee with Criminal Background clearance instructions for a previous uncleared adult citation and Civil Penalty on 08/09/2021. Licensee had two children in care.

Licensee received a letter from Guardian stating clearance for an uncleared adult was no longer pending and was closed. Licensee requested assistance from LPA Gibson. LPA Gibson reviewed the LIC 531 and confirmed with the Licensee the letter was correct clearance is no longer pending. Uncleared adult will have to reprint. LPA Gibson reviewed the previous Live Scan application and observed two errors Line 3 and Line 6 were not filled out. Uncleared adult was only partially cleared. LPA Gibson provided a new Live Scan packet assisted Licensee with instructions on how to fill out the form. Licensee will have uncleared adult reprint today.

In addition, LPA Gibson went over the Safe Sleep Regulations and provided the Licensee the LIC 9227.

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: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
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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