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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203909760
Report Date: 08/02/2023
Date Signed: 08/02/2023 02:17:21 PM


Document Has Been Signed on 08/02/2023 02:17 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MARAVILLA, MATILDE FAMILY CHILD CAREFACILITY NUMBER:
203909760
ADMINISTRATOR:MARAVILLA, MATILDEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 514-3476
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 8DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Matilde Maravilla TIME COMPLETED:
02:20 PM
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On 08/02/23 Licensing Program Analyst (LPA) Denisia Jimenez conducted an unannounced case management inspection to inspect the additional room that will be used for primary day care. LPA met with licensee Matilde Maravilla who is caring for 8 children with the help of her assistant. LPA observed the room is enclosed with 3 doors, toys, a table, air conditioner, mattress and storage cabinet anchored to the wall. The room is connected to the kitchen. The sliding door in the kitchen was removed and converted into a barn door. Licensee stated the garage was converted into a room after getting approved for a large license in 2019, therefore licensee needs a new fire clearance. LPA gave licensee form LIC9054 Fire Inspection Authority to request a new fire clearance. LPA explained to licensee once the department gets the fire inspection clearance, Licensee will submit pictures to LPA and the room will be approved for primary day care use. Licensee was reminded to notify licensing if there are ever any other structural changes to her home. Licensee understood.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. Exit interview conducted with Licensee, Matilde Maravilla. This report is to be made available to the public upon request.

LIC 9213 Notice of Site Visit to be posted for 30 day.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Denisia JimenezTELEPHONE: (559) 767-0718
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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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