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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203904637
Report Date: 05/09/2022
Date Signed: 05/09/2022 01:08:21 PM


Document Has Been Signed on 05/09/2022 01:08 PM - It Cannot Be Edited

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:MORENO, MARIA FAMILY CHILD CAREFACILITY NUMBER:
203904637
ADMINISTRATOR:MORENO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 352-6258
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 5DATE:
05/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Aime Rodriguez - AssistantTIME COMPLETED:
01:15 PM
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On 05/09/2022, Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection due to licensee wanting to make backyard play area available for the daycare children. LPA was met by Assistant, Aime Rodriguez. Licensee was not home during the inspection. Assistant confirmed the daycare room, living room, kitchen, dining room, and bathroom #1 are used for providing care and are accessible to children. There is one small dog. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets.

LPA reviewed the backyard and observed the area to be free of hazards. LPA observed various toys and equipment that are age appropriate for children. There is no swimming pool or other bodies of water on the premises. The backyard is approved for day care use.

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

Exit interview conducted and report was reviewed with the facility representative, Aime Rodriguez. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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