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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203804609
Report Date: 12/11/2019
Date Signed: 12/11/2019 02:17:36 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:COSIO FAMILY CHILD CAREFACILITY NUMBER:
203804609
ADMINISTRATOR:COSIO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-1453
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 6DATE:
12/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Maria CosioTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Case Management inspection and met with Licensee, Maria Cosio and husband. LPA explained the reason of the inspection and a tour of the home was conducted. LPA observed that licensee was caring for 6 children.

LPA requested copies of the children's roster and observed that everything was completed and up to date. Licensee provided proof that herself and 3 assistants were up to date with the immunization requirements. LPA observed that the sharp utensils and vitamins are placed up high so children don't have access to them. A sampling of children's records was reviewed and LPA observed that everything was complete and up to date. All the bedroom doors have a plastic door knob so children dont have access to them.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are cited today. During the exit interview, LPA viewed the LIC9213 being posted and reminded licensee that it needs to be posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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