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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203908603
Report Date: 08/16/2021
Date Signed: 08/16/2021 03:54:18 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:VARGAS, MARIA FAMILY CHILD CAREFACILITY NUMBER:
203908603
ADMINISTRATOR:VARGAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 481-5134
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 1DATE:
08/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Maria VargasTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Brannon and Yanez conducted a POC visit. LPAs met with licensee, Maria Vargas. During today's inspection, LPAs toured the facility and reviewed staff files.

Per California Code of Regulations Title 22, no deficiency cited during today's visit. Exit interview conducted with the licensee,Maria Vargas. A copy of this report shall be placed in facility file for public review. 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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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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