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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223910603
Report Date: 05/27/2020
Date Signed: 05/27/2020 04:22:31 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:MUNSON, KENDRA FAMILY CHILD CAREFACILITY NUMBER:
223910603
ADMINISTRATOR:MUNSON, KENDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 628-3143
CITY:MARIPOSASTATE: CAZIP CODE:
95338
CAPACITY:14CENSUS: 10DATE:
05/27/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Kendra MunsonTIME COMPLETED:
04:30 PM
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On 05/27/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted a virtual Case Management inspection with Licensee Kendra Munson via Face Time due to COVID-19 restrictions.

The purpose of this inspection was to observe a bedroom which was previously made off-limits to day care children and make the bedroom accessible to children in care. LPA observed children's toys and furniture in the room. LPA verified bedroom #1 was appropriate for day care use.

LPA requested for Licensee to provide an updated facility sketch (LIC 999A) and send it to the Fresno Regional Child Care Office.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited during the inspection.

Exit interview was conducted with Licensee. LPA advised Licensee a copy of the Facility Evaluation Report (LIC 809), as well as the Notice of Site Visit (LIC 9213), will be emailed to Licensee. LPA requested for Licensee to sign the LIC 809 and return the signed copy to LPA. Licensee was also advised the Notice of Site Visit (LIC 9213) needs to be posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2020
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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