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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543903669
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:45:07 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:ORTIZ, DEBORAH FAMILY CHILD CAREFACILITY NUMBER:
543903669
ADMINISTRATOR:ORTIZ, DEBORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 920-0860
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 3DATE:
10/15/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Deborah Ortiz, LicenseeTIME COMPLETED:
02:00 PM
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LPA Pete Espinoza conducted Plan of Correction visit today regarding deficiencies cited on 07/15/2019. LPA met with Deborah Ortiz, Licensee.

Licensee provided proof of required immunization (Pertussis/Measles/Influenza) and written declaration declining flu shot AND Certificate of Completion for required Mandated Reporter Training.

Licensee provided completed records for review for all children enrolled in day-care.

During visit LPA provided Letter of Deficiency Citations Cleared.

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: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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