<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909242
Report Date: 03/15/2024
Date Signed: 03/15/2024 01:45:17 PM


Document Has Been Signed on 03/15/2024 01:45 PM - 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:BELERIQUE, NANCY FAMILY CHILD CAREFACILITY NUMBER:
503909242
ADMINISTRATOR:BELERIQUE, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 480-7370
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 11DATE:
03/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:NANCY BELERIQUETIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/15/2024, an unannounced Case Management inspection was conducted by Licensing Program Analyst Valerie Mireles. LPA met with Licensee, Nancy Belerique. The purpose of the inspection is to obtain signatures and provide copies of an amended report that was originally completed on 03/16/2022 by LPA Stefanie Galvan.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiency is being cited during today's visit. LIC 9213 Notice Of Site visit form was provided to Licensee and is required to be posted for 30 days. This report shall be made available to the public upon request.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Valerie MirelesTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1