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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808141
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:46:26 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:TIPTON CHILD DEVELOPMENT CENTERFACILITY NUMBER:
543808141
ADMINISTRATOR:MARTIN, JOSEFAFACILITY TYPE:
850
ADDRESS:370 N. EVANSTELEPHONE:
(559) 651-3022
CITY:TIPTONSTATE: CAZIP CODE:
93272
CAPACITY:15CENSUS: 6DATE:
10/12/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lead Teacher, Lilia PerezTIME COMPLETED:
12:00 PM
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On 10/12/21, Licensing Program Analyst (LPA) Jose Penate conducted an unannounced case management visit. LPA met with Site Supervisor (SS), Lilia Perez. LPA received an unusual incident report regarding an incident occurring on 8/25/2021. LPA interviewed staff, and discussed with SS on staff training's and to continue to follow the personal rights of children.

Per California Code of Regulations, Title 22, Division 12, no deficiencies were found.

Exit interview was conducted with Site Supervisor, Lilia Perez.

A Notice of Site Visit form (LIC 9213) and a copy of the Facility Evaluation Report (LIC 809) were left with SS.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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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