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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243810167
Report Date: 05/06/2022
Date Signed: 05/06/2022 03:17:08 PM


Document Has Been Signed on 05/06/2022 03:17 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:SAN LUIS EARLY HEAD STARTFACILITY NUMBER:
243810167
ADMINISTRATOR:MENDOZA, MISTYFACILITY TYPE:
830
ADDRESS:129 7TH STREETTELEPHONE:
(209) 827-5691
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:8CENSUS: 0DATE:
05/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Misty MendozaTIME COMPLETED:
03:45 PM
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On May 6, 2022, Licensing Program Analyst (LPA) C Brannon met with Site Supervisor, Misty Mendoza. Licensee, Merced Office of Education, Regional Head Start, is requesting a capacity of 4 infants with 4 crib babies and 4 toddlers in the toddler option.

Previous inspection was conducted on 4/14/22. During today's inspection, LPA observed that the required bolt threads were shaved down to the recommended of only having 2 - 3 threads showing.

LPA observed that the two changing tables had the required changing pad.

Pending a final file review, a recommendation will be made to license the above facility with an infant license of 8 children: 4 Infants & 4 Toddlers.

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: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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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