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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543902347
Report Date: 12/19/2019
Date Signed: 12/19/2019 02:35:34 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:LEMUS, ELOISA FAMILY CHILD CAREFACILITY NUMBER:
543902347
ADMINISTRATOR:LEMUS, ELOISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 562-6419
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY:14CENSUS: 3DATE:
12/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Eloisa LemusTIME COMPLETED:
02:35 PM
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On this date, Licensing Program Analyst (LPA) Diane Mercado conducted an unannounced Case Management Inspection. LPA met with licensee, Eloisa Lemus also present was Licensee daughter who is her assistant. LPA toured the facility and a census was taken. The purpose of today's inspection was to discuss residents living in the home.

Licensee confirmed adults and children living in the home and/or associated to the facility. Licensee signed and dated Licensing Information System 531 confirming residents associated to facility.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiency was cited during today’s inspection. Exit interview conducted with Eloisa Lemus.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 day.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane MercadoTELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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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