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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543908443
Report Date: 11/25/2019
Date Signed: 12/02/2019 09:29:19 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:PENA, JANIE FAMILY CHILD CAREFACILITY NUMBER:
543908443
ADMINISTRATOR:PENA, JANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 741-1966
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 8DATE:
11/25/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Janie Pena - Licensee TIME COMPLETED:
05:15 PM
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On this date, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Janie Pena to discuss the POC associated to the deficiency cited on 11/21/2019. Today, LPA confirmed that the licensee has equipped the pool the gate in question with a latching fixture that is less than six inches from the top of the gate, thereby clearing the deficiency previously cited.

LPA provided the licensee with a "Letter of Deficiency Citations Cleared." Letter must be filed at the facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
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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