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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503807646
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:37:26 AM


Document Has Been Signed on 09/22/2022 11:37 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:TAFOYA, FRANCES FAMILY CHILD CAREFACILITY NUMBER:
503807646
ADMINISTRATOR:TAFOYA, FRANCESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 548-9796
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Frances Tafoya TIME COMPLETED:
11:45 AM
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On 9/22/22, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced visit to complete an annual inspection with Licensee Frances Tafoya, however, Licensee requested an inactive license status for 1 year. LPA provided the form and obtained signature.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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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