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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500318152
Report Date: 04/19/2024
Date Signed: 04/19/2024 09:32:18 AM


Document Has Been Signed on 04/19/2024 09:32 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:WILLIAMS, PATTIFACILITY NUMBER:
500318152
ADMINISTRATOR:WILLIAMS, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 521-5889
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 4DATE:
04/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Patti WilliamsTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Erica Pacheco made an unannounced Plan of Correction visit today. The purpose of today's visit was to verify that licensee completed the mandated reporter training and conducted a fire drill. During the time of the visit, census was taken and LPA confirmed that licensee had completed all plan of corrections. Plan of corrections will be cleared as of today's date.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.


LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Erica PachecoTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
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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