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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910659
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:36:43 AM


Document Has Been Signed on 11/17/2023 11:36 AM - 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:CERVANTES, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910659
ADMINISTRATOR:CERVANTES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 626-0520
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY:14CENSUS: 0DATE:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria CervantesTIME COMPLETED:
12:00 PM
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On 11/17/2023, Licensing Program Analyst (LPA) Priscilla Zamudio attempted to complete an unannounced required annual inspection. LPA was met by licensee Maria Cervantes who stated that she was no longer operating the daycare as of yesterday. She allowed LPA entry and the home appeared to be in the process of being packed. LPA also discussed a recent incident reported to the office.

Ms. Cervantes stated she is requesting closure and will be moving out of the state. This will serve as licensee's request to close. Ms. Cervantes was informed she will need to reapply again in the future, if interested in obtaining a child care license.

License to be closed as of this date, per licensee request.
SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023
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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