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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500315166
Report Date: 10/04/2024
Date Signed: 10/04/2024 09:20:36 AM


Document Has Been Signed on 10/04/2024 09:20 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CAPISTRANO HEAD STARTFACILITY NUMBER:
500315166
ADMINISTRATOR:CONSUELO CENTENOFACILITY TYPE:
850
ADDRESS:400 CAPISTRANO DRIVETELEPHONE:
(209) 527-9865
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY:62CENSUS: 25DATE:
10/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Jazmin RuizTIME COMPLETED:
09:30 AM
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On October 4, 2024, Licensing Program Analyst (LPA) Yesenia Fierro conducted an unannounced licensee-initiated case management inspection. LPA met with Early Head Start and Family Service Supervisor Jazmin Ruiz. A census was taken. LPA toured the facility inside and outside. The purpose for the inspection was to inspect and determine if classroom 3 meets the standards to be used to care for children of the age of two (2).

LPA inspected classroom 3 and observed age-appropriate equipment, furniture and toys for children. Classroom 3 meets or exceeds departments standards and is fully equipped with carbon monoxide detectors, fire alarms and fire extinguishers. There are a sufficient number of toilets and sinks for the children.

Early Head Start and Family Service Supervisor Jazmin Ruiz stated classroom 3 will enroll up to eight (8) children and will have their own schedule outdoor play time.

STD 850 Fire Safety Inspection report was received and verified from the Modesto Fire Department. The Early Head Start and Family Service Supervisor Jazmin Ruiz will provide LPA with an updated facility sketch to ensure the accuracy of the areas being used for the license.

Effective immediately classroom 3 may be used for the care and supervision of children.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency cited.

An exit interview conducted with Early Head Start and Family Service Supervisor Jazmin Ruiz and a copy of this report was provided and discussed.

A Notice of Site Visit Form (LIC 9213) was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Kari McWilliamsTELEPHONE: (559)341-5422
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024
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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