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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503908292
Report Date: 10/09/2019
Date Signed: 10/09/2019 11:52:19 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:MARTINEZ, DIANNA FAMILY CHILD CAREFACILITY NUMBER:
503908292
ADMINISTRATOR:MARTINEZ, DIANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 380-4059
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:14CENSUS: 4DATE:
10/09/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dianna MartinezTIME COMPLETED:
12:15 PM
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On 10/09/2019, Licensing Program Analyst (LPA) Candis Rodriguez and Licensing Program Manager (LPM) Alice Juarez conducted a case management visit to obtain signatures for annual inspection report dated 10/07/2019. LPA was unable to obtain signatures and print report on 10/07/2019 due to a consistency check on LPAs computer. See above referenced report for more information.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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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