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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163910561
Report Date: 01/23/2020
Date Signed: 01/24/2020 10:02:54 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: 8DATE:
01/23/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Samantha QuinnTIME COMPLETED:
12:50 PM
NARRATIVE
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility and met with Licensee, Samantha Quinn. LPA toured the facility and census was taken. The purpose of this inspection was to discuss delinquent fees. LPA informed Licensee of the outstanding fees in the amount of $140.00 that are due. LPA provided Licensee with a copy of Facility Transaction History (CLF551M1) indicating assessed fees. Licensee paid the fees on-line while LPA was at the facility.

Per California Code of Regulations, Division 12, Title 22 of the California Code of Regulations, the following deficiency was found (see next page):

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: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 163910561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2020
Section Cited

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An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803: (Health and Safety Code Section 1596.803 provides: (a) An application fee adjusted by facility and capacity shall be charged by the department for the issuance of an original license to operate a child day care
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facility.) This requirement was not met as evidenced by an outstanding balance of $140.00 for the facility. This poses a potential risk to the health, safety, or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2020
LIC809 (FAS) - (06/04)
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