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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911033
Report Date: 03/22/2023
Date Signed: 03/22/2023 10:51:40 AM


Document Has Been Signed on 03/22/2023 10:51 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:GIBBONS, SARA FAMILY CHILD CAREFACILITY NUMBER:
153911033
ADMINISTRATOR:GIBBONS, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 369-6585
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:14CENSUS: 6DATE:
03/22/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sara GibbonsTIME COMPLETED:
10:30 AM
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On 03/22/2023, Licensing Program Analyst (LPA) Nancy Her conducted an unannounced case management inspection due to licensee wanting to add the outdoor atrium to her day-care. LPA was met by Licensee, Sara Gibbons. LPA observed safe children's toys, books and safe equipment in the home. There is a functioning smoke detector, carbon monoxide detector, and fire extinguisher. The outdoor atrium is approved for day care use effective 03/22/2023. Licensee submitted a new facility sketch for the accessible areas in her home.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with the facility representative Sara Gibbons.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Nancy HerTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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