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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543804699
Report Date: 10/07/2021
Date Signed: 10/07/2021 03:04:23 PM

Document Has Been Signed on 10/07/2021 03:04 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KARENA'S LITTLE TYKES DAY CAREFACILITY NUMBER:
543804699
ADMINISTRATOR:FLORER, KARENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 685-0943
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
10/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karena FlorerTIME COMPLETED:
09:45 AM
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On 10/07/2021 Licensing Program Analyst (LPA) Nancy Her, conducted an unannounced Case Management Visit and was met by Licensee Karena Florer. The purpose of today’s visit was to record and final print the annual inspection that was conducted on 10/01/2021. While conducting the annual inspection on 10/01/2021, LPA went into consistency check therefore report was unable to be recorded and final printed.

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

Exit interview conducted and report was reviewed with the facility representative Karena Florer.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
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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