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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543905345
Report Date: 02/24/2020
Date Signed: 02/25/2020 08:03:59 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:RENTERIA, DORA FAMILY CHILD CAREFACILITY NUMBER:
543905345
ADMINISTRATOR:RENTERIA, DORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 687-9776
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:14CENSUS: 11DATE:
02/24/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Dora RenteriaTIME COMPLETED:
11:30 AM
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On 2/24/2020, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced plan of correction inspection at the facility. LPA met with Licensee, Dora Renteria, to verify a plan of correction for the deficiency that was cited on 2/5/2020. LPA reviewed files for day care children that did not contain mandatory immunization documentation to ensure the deficiency was corrected.

Based on observations by LPA of the documents, LPA determined the Licensee corrected the deficiency.

Per California Code of Regulations, Title 22, Division 12, no deficiencies cited during today's inspection.

Exit interview conducted with Licensee. Licensee provided with a copy of the Facility Evaluation Report, the LIC 9213 Notice of Site Visit, and the Letter of Deficiency Citations Cleared. The Facility Evaluation Report is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020
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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