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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910049
Report Date: 06/30/2022
Date Signed: 06/30/2022 10:15:37 AM

Document Has Been Signed on 06/30/2022 10:15 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CONTRERAS, BERTHA FAMILY CHILD CAREFACILITY NUMBER:
153910049
ADMINISTRATOR:CONTRERAS, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 621-1398
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Bertha Contreras - Licensee TIME COMPLETED:
10:15 AM
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On 6/30/22, an unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Bertha Contreras. Staff #2 and seven children were also present on this date.

LPA Thompson conducted an unannounced Annual Random inspection on 06/29/22, however, due to computer issues, LPA Thompson was unable to provide Licensee with a copy of the LIC809, LIC809-C, LIC809-D, Appeal Rights, Civil Penalty Assessment, and Notice Of Site Visit forms associated to the inspection. On this date, LPA obtained pertinent signatures from Licensee and provided Licensee with copies of the aforementioned documents.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited during today's inspection.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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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