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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910561
Report Date: 05/09/2019
Date Signed: 05/09/2019 11:35:25 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:QUINN, SAMANTHA FAMILY CHILD CAREFACILITY NUMBER:
163910561
ADMINISTRATOR:QUINN, SAMANTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 309-2381
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: 14DATE:
05/09/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Samantha QuinnTIME COMPLETED:
11:45 AM
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Licensing Program Analyst Brannon conducted a case management visit. LPA met with two assistants. Licensee was not present when LPA opened inspection visit. Licensee arrived during LPA's inspection. LPA arrived at facility and took a census. There were 14 children present.

Licensee has a pool that meets Title 22 requirements. Licensee has three dogs that are kept in the fenced side yard. At this time, the backyard is off-limits. Licensee is aware that she is liable for the actions of her pets. Licensee is aware that Licensing is required to conduct an inspection visit before the children can utilize the backyard. LPA reviewed staff files.

Per California Code of Regulations Title 22, no deficiency to be cited during today's visit. Exit interview conducted with licensee, Samantha Quinn. A Notice of Site Visit was posted on parent board.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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