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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543807642
Report Date: 07/01/2021
Date Signed: 07/02/2021 07:30:06 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:RODRIGUEZ, ANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543807642
ADMINISTRATOR:RODRIGUEZ, ANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 739-0192
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 6DATE:
07/01/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angelina RodriguezTIME COMPLETED:
02:00 PM
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On 7/01/21, an unannounced Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Angelina Rodriguez. LPA toured the facility and a census was taken.

LPA Thompson conducted an unannounced Required 1 Year inspection on 6/30/21; however, due to computer issues, LPA Thompson was unable to provide Licensee with a copy of all reports associated the inspection. On this date, LPA provided Licensee with all related reports. Additionally, LPA reviewed with Licensee all Plan of Corrections with a due date of 7/1/21 associated to deficiencies cited on 6/30/21. Today, LPA verified the following:

· Licensee has filled the front yard fountain with rocks making the water level above the rocks scant; Licensee has emptied water from the back yard fountain a placed a gate around it making it inaccessible to children; Licensee has emptied water in the concrete dog bowl
· Licensee has removed, from areas accessible to children, all hazardous items in the backyard

LPA cleared the above 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 were 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: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
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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