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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543809139
Report Date: 01/06/2020
Date Signed: 01/06/2020 01:49:25 PM

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:RANGEL, ELIDIA FAMILY CHILD CAREFACILITY NUMBER:
543809139
ADMINISTRATOR:RANGEL, ELIDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 586-1650
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY:14CENSUS: 2DATE:
01/06/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Elidia RangelTIME COMPLETED:
02:05 PM
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On this date, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Diane Mercado. LPA met with Licensee Elidia Rangel to review the POC associated to deficiencies cited on 11/13/19. Licensee is Spanish speaking; therefore, LPA Mercado provided interpretive services. LPA toured facility inside and outside, and census was taken. LPA reviewed files for children that did not contain immunization records to ensure the deficiencies were corrected. Today, LPA verified the following:
  • Children Immunizations (102418)(g)

LPA cleared deficiency 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.

During todays inspection LPA asked Licensee to verify mailing address and phone number. LPA cleared two deficiencies and mailed "Letter of Deficiency Citations Cleared” on 11/21/19 to Licensee. LPA received the letter on 12/03/19 as return to sender. LPA has tried contacting Licensee by phone, but licensee does not have voicemail set up. LPA discussed with licensee what is the correct mailing address and correct phone number.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today. Exit interview conducted with Licensee.
LIC 9213 Notice of Site Visit Form is required to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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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