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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909948
Report Date: 10/01/2019
Date Signed: 10/01/2019 11:13:36 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:WATSON, KRISTIAN FAMILY CHILD CAREFACILITY NUMBER:
153909948
ADMINISTRATOR:WATSON, KRISTIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 759-9754
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:14CENSUS: 8DATE:
10/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristian Watson - Licensee TIME COMPLETED:
11:00 AM
NARRATIVE
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On this date, Licensing Program Analyst (LPA) Jessika Thompson conducted Case Management inspection. LPA met with Licensee Kristian Watson and a tour of the facility was made. The purpose of today’s inspection was to discuss past due licensing fees. LPA informed Licensee that she currently owes a total of $209.50, which is past due. LPA provided a copy of the Licensing Information System, Facility Transaction History printout, reflecting current payment information.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, this deficiency is being cited on the attached LIC-809D.

An exit interview conducted with Licensee Kristian Watson.

A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WATSON, KRISTIAN FAMILY CHILD CARE
FACILITY NUMBER: 153909948
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2019
Section Cited

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Licensing Fees: An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803. After initial licensure, a fee shall be charged by the department
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annually, on each anniversary of the effective date of the license. This requirement was not met, as licensee currently owes a total of of $209.50 in annual & late licensing fees.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2019
LIC809 (FAS) - (06/04)
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