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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500308169
Report Date: 12/20/2022
Date Signed: 12/21/2022 10:45:49 AM


Document Has Been Signed on 12/21/2022 10:45 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CAPDEVIELLE, LINDAFACILITY NUMBER:
500308169
ADMINISTRATOR:CAPDEVIELLE, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 527-7058
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Linda CapdevielleTIME COMPLETED:
11:20 AM
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On 12/20/22, LPA Priscilla Zamudio attempted to conduct an annual inspection, however, licensee Linda Capdevielle stated that she is requesting to close. Licensee submitted a written statement to close on the back of the Child Care License.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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