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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243800115
Report Date: 01/06/2020
Date Signed: 01/06/2020 02:00:41 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:MERCEDES FAMILY DAY CARE HOMEFACILITY NUMBER:
243800115
ADMINISTRATOR:RODRIGUEZ, MERCEDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 383-2911
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:14CENSUS: 7DATE:
01/06/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Mercedes Rodriguez - LicenseeTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced Case Management - Licensee Initiated inspection. LPA met with Licensee, Mercedes Rodriguez. Also present was Licensee’s assistant. The purpose of today’s inspection was to inspect the structural change in the family child care home. LPA observed that Licensee had removed a wall in the home between the day care room and a bedroom to expand the day care room. LPA observed in the expanded day-care room furniture equipment and toys that are age appropriate. LPA also observed a changing table and two hand washing sinks. Expanded room contains a ceiling fan, two ceiling lights and has fully insulated walls and electric outlets. There is adequate heating and ventilation for safety and comfort. Licensee provided LPA with a revised facility sketch. Licensee informed LPA that the local fire authority is scheduled to inspect the room on Friday, January 10, 2020. LPA has found the room to be safe for day care children to use pending the report from the local fire authority.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiencies cited during today's visit.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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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