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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543805896
Report Date: 05/01/2019
Date Signed: 05/01/2019 09:47:50 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:MAGALLON FAMILY CHILD CAREFACILITY NUMBER:
543805896
ADMINISTRATOR:MAGALLON, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 793-4197
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 6DATE:
05/01/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angelica Magallon, LicenseeTIME COMPLETED:
10:00 AM
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LPA Pete Espinoza conducted Plan of Correction visit today regarding deficiencies cited on 04/17/2019. LPA met with Angelica Magallon, Licensee.

LPA reviewed children's files and observed completed Consent for Medical Treatment Form in each child's files.

Licensee provided proof of required Mandated Reporter Training - Certificate of Completion dated: 12/17/2017.

During visit LPA provided Letter of Deficiency Citations Cleared. Exit interview conducted with Angelica Magallon, Licensee.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
A Notice of Site Visit was posted on parent board.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
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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