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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910533
Report Date: 09/27/2019
Date Signed: 09/27/2019 03:26:12 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:SAN NICHOLAS, CHRISTINA FAMILY CHILD CAREFACILITY NUMBER:
163910533
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
09/27/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Christina San NicholasTIME COMPLETED:
01:40 PM
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection and met with Licensee, Christina San Nicholas. The purpose of the inspection was to observe the play area of the facility and the swimming pool fence in the back yard.

LPA observed the swimming pool fence to meet Community Care Licensing (CCL) regulations. License stated the back yard play area is currently off-limits to the day care children and she would like to utilize the front yard for the day care play area until the back yard is accessible for day care children. LPA inspected the front yard of the facility and verified it was appropriate for day care children to use. LPA advised Licensee there needs to be supervision at all times when the day care children are playing in the front yard.

LPA advised Licensee the back yard will need to be inspected by CCL prior to day care use.

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

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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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