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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503910347
Report Date: 10/01/2024
Date Signed: 10/01/2024 11:40:41 AM


Document Has Been Signed on 10/01/2024 11:40 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:CLEMANS, MARIVIC FAMILY CHILD CAREFACILITY NUMBER:
503910347
ADMINISTRATOR:CLEMANS, MARIVICFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 812-5977
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:14CENSUS: 8DATE:
10/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marivic ClemansTIME COMPLETED:
12:00 PM
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On 10/01/2024 Licensing Program Analyst (LPA) Anita Tristan conducted an unannounced case management inspection and met with Licensee Marivic Clemins and informed her of the purpose of the inspection. LPA toured the facility and a census was taken. Also present was licensee’s daughter/assistant.

LPA Tristan went over the Confirmation of Removal for Licensee's husband with Licensee and ensured that he was not currently at the facility. Licensee stated that he does live at the facility but is only present after hours and is not at the facility while children are in care.

LPA asked licensee if she received a copy of the Confirmation of Removal. Licensee stated she had received a copy.

LPA provided a copy of the Confirmation of Removal to licensee and reminded licensee that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.



Licensee understands failure to comply with the terms, and conditions will result in the Department taking further administrative action.

Licensee Signed Removal Confirmation.

Exit interview conducted and report was reviewed with the Licensee, Marivic Clemins.



Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Notice of site visit was provided and will be posted for 30 days.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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