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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543805379
Report Date: 01/14/2020
Date Signed: 01/15/2020 09:27:16 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:OLIVAS FAMILY CHILD CAREFACILITY NUMBER:
543805379
ADMINISTRATOR:OLIVAS, EMMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 735-9018
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:14CENSUS: DATE:
01/14/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:TIME COMPLETED:
01:00 PM
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On this date, Licensing Program Analyst attempted an unannounced annual inspection. There was no answer at the door. LPA called phone number listed in LIS 055M, but there was no answer. LPA left card at licensee' door.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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