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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503910236
Report Date: 04/17/2023
Date Signed: 04/18/2023 09:09:16 AM


Document Has Been Signed on 04/18/2023 09:09 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:VEGAS LOPEZ, JUNE FAMILY CHILD CAREFACILITY NUMBER:
503910236
ADMINISTRATOR:VEGAS LOPEZ, JUNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 585-5433
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:14CENSUS: DATE:
04/17/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
12:30 PM
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On 4/17/2023 Licensing Program Analyst (LPA) Anita Tristan attempted a Required 1- year visit. Licensee was not home.

LPA attempted to call Licensee, there was no answer; LPA left detailed voice message to return call and that LPA was at the Family Child Care Home and to do an annual inspection and that we needed to hear from Licensing. LPA left 10 day letter on door.
SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023
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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