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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909735
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:14:23 AM


Document Has Been Signed on 06/01/2022 11:14 AM - It Cannot Be Edited

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:PENA, ROBBIN FAMILY CHILD CAREFACILITY NUMBER:
153909735
ADMINISTRATOR:PENA, ROBBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 746-2841
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:14CENSUS: 4DATE:
06/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Robbin Pena - Licensee TIME COMPLETED:
11:15 AM
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On 6/1/2022, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Robbin Pena to review the POCs associated to deficiencies cited on 4/22/22. Today, LPA verified the following:

· Licensee has completed and logged a fire & disaster drill
· Licensee completed a Child Abuse Mandated Reporter Training course on 5/11/122
· Licensee maintains proof of immunization for children in care within the family child care home
· Licensee's backyard is free of hazards

Licensee has a CPR course scheduled to be completed within the next couple weeks. Licensee was advised to provide LPA with proof of CPR certification upon completion.

LPA cleared deficiencies cited on 4/22/22 today and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

No deficiencies were cited on this date. 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: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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