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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503608405
Report Date: 10/29/2019
Date Signed: 10/29/2019 10:55:48 AM

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:TENDER HEARTS CHILDCARE CENTERFACILITY NUMBER:
503608405
ADMINISTRATOR:GALVAN, CONNIEFACILITY TYPE:
830
ADDRESS:2118 WOODLAND AVE.TELEPHONE:
(209) 550-5930
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY:20CENSUS: 13DATE:
10/29/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Connie GalvanTIME COMPLETED:
11:00 AM
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On 10/29/2019, Licensing Program Analysts (LPAs) Angelica Mejia and Luisa Gavoutian conducted an unannounced Case Management inspection and met with Director Connie Galvan. LPAs explained the reason for the inspection, conducted a tour of the facility both inside and outside, and a census was taken.

The purpose of today’s inspection was to obtain Licensee’s signatures for an Annual inspection report dated 10/24/2019. LPA Mejia was unable to obtain signatures and provide copies of the report on 10/24/2019 due to a technical failure with Licensing equipment. LPA Mejia also attempted a Case Management inspection on 10/28/2019 that could not be completed due to a consistency check on Licensing equipment. See above referenced report for more information.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.


LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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