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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910533
Report Date: 05/04/2020
Date Signed: 05/29/2020 09:27:48 AM

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:SAN NICHOLAS, CHRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 530-9128
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: DATE:
05/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Christina San NicholasTIME COMPLETED:
10:20 AM
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On 5/4//2020, Licensing Program Analyst (LPA) Kathy Pacheco conducted a virtual case management inspection, with Licensee, Christina San Nicholas, via Face Time, due to COVID-19 restrictions.

The inspection was to observe the back yard area of the home that was previously made off-limits to day care children. LPA verified the back yard area was appropriate for day care children to use. LPA also observed the above ground swimming pool, located in the back yard, to meet Title 22 regulation requirements and have a self-latching gate that swings away from the swimming pool.

Licensee stated the day care children will have access to the swimming pool. Licensee was reminded that full supervision is required outdoors when children are utilizing the swimming pool.

LPA requested for Licensee to provide an updated facility sketch (LIC 999-A) and send it to the Fresno Community Care Licensing Office.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited during the inspection.

Exit interview was conducted with Licensee. LPA advised Licensee a copy of the Facility Evaluation Report (LIC 809), as well as, the Notice of Site Visit (LIC 9213) would be emailed to Licensee. LPA requested for Licensee to sign the LIC 809 and return the signed copy to LPA. Licensee was also reminded the LIC 9213 needs 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: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
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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