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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808796
Report Date: 06/14/2019
Date Signed: 06/14/2019 10:07:23 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:MUNCY CDCFACILITY NUMBER:
503808796
ADMINISTRATOR:MASTRPIERRO, MALISSAFACILITY TYPE:
850
ADDRESS:2410 JANNA AVENUETELEPHONE:
(408) 556-7300
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:96CENSUS: 22DATE:
06/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Malissa MastropierroTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Brannon met with Site Supervisor, Malissa Mastropierro. LPA observed four staff with 22 children.

LPA verified that adult #1 was not working at any of licensee's facilities. LPA spoke with Villalovoz CDC Site Supervisor Christy Ziller over the phone. Per Christy Ziller, adult #1 did work at the facility. Upon receiving notice of exemption denial, adult #1 has not returned to facility.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with Site Supervisor, Malissa Mastropierro. A copy of this report need to be placed in facility file for public review. A Notice of Site Visit was posted on parent board.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW. THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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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