<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243809958
Report Date: 11/13/2019
Date Signed: 11/13/2019 12:19:23 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:GOMEZ, BERTHA FCCFACILITY NUMBER:
243809958
ADMINISTRATOR:GOMEZ, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 382-2612
CITY:PLANADASTATE: CAZIP CODE:
95365
CAPACITY:14CENSUS: 5DATE:
11/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Bertha Gomez - LicenseeTIME COMPLETED:
01:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Joseph Pacheco and Jose Penate arrived at the family day care home to conduct an unannounced Case Management inspection. LPAs met with Spanish speaking Licensee, Bertha Gomez. LPAs toured the home inside and outside and census was taken.

Licensee is having construction done to the front patio area of the home. This construction makes areas that would normally be accessible to day care children, off-limits due to construction equipment and furniture being moved for completion of job. Licensee stated once construction is done she will contact CCL to inform that normal activities have been resumed. Approximate construction completion date of 11/23/2019 was given by the Licensee. Licensee stated she will send proof of completion via photos to LPA Pacheco.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1