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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910678
Report Date: 08/20/2020
Date Signed: 08/20/2020 02:06:03 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:MEJIA, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
153910678
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
08/20/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sandra MejiaTIME COMPLETED:
02:15 PM
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On 08/20/2020 Licensing Program Analyst (LPA) Diane Mercado conducted a televisit via telephone (facetime) due to COVID-19 related matters and as means of precaution. Purpose of today's telephone inspection was to conduct a virtual tour of the living room Licensee would like to utilize the living room to care for children.

LPA observed in the living room two couches and a table appropriate for day care children. LPA did not observe any hazardous items.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies observed during today’s inspection. Exit interview was conducted with Licensee.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020
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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