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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163903825
Report Date: 07/25/2022
Date Signed: 10/18/2022 11:21:16 AM


Document Has Been Signed on 10/18/2022 11:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/18/2022 11:13 AM

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

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This case management report document was created and final printed on 7/25/2022 in error. There was no case management inspection completed at this facility on 7/25/2022. The case management inspection was for a facility in a different location with the same last and first name (Luna, Maria FCC). This document was created in error and the error was discovered by Licensing Program Analyst (LPA) Ocegueda on 10/3/2022 and after consultation was corrected by amending this report on 10/18/2022.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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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