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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163908437
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:26:50 AM


Document Has Been Signed on 11/29/2022 11:26 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:CHAVEZ-ANDRADE, YNEZ FAMILY CHILD CAREFACILITY NUMBER:
163908437
ADMINISTRATOR:CHAVEZ-ANDRADE, YNEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 836-0876
CITY:KETTLEMAN CITYSTATE: CAZIP CODE:
93239
CAPACITY:14CENSUS: 5DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Ynez Chavez-AndradeTIME COMPLETED:
11:30 AM
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On 11/29/2022 Licensing Program Analyst (LPA) Nancy Her conducted an unannounced Case Management visit to deliver an "amended report", LIC9099. Prior visit was made on 11/09/2022, see LIC9099 dated 11/09/2022. LPA was met by Licensee Ynez Chavez- Andrade. LPA toured the facility and a census was taken.

LPA and Licensee discussed amended report; report went from "Confidential" to "Public". LPA and Licensee signed the amended report.

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 Ynez Chavez-Andrade.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Nancy HerTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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