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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543805875
Report Date: 09/26/2019
Date Signed: 09/26/2019 11:19:49 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:FELIZ DAY CAREFACILITY NUMBER:
543805875
ADMINISTRATOR:DELGADO, FELISIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 625-2729
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 4DATE:
09/26/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Felisiana Delgado - Licensee TIME COMPLETED:
11:00 AM
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On this date, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Felisiana Delgado to review the POCs associated to deficiencies cited on 08/21/19 Today, LPA verified the following:

· Licensee maintains Parent’s Rights form 995A for children in care
· Licensee maintains proof of immunization for children in care
· Licensee maintains emergency information for children in care

LPA cleared deficiencies on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

No deficiency cited on this date.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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