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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910940
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:05:47 AM


Document Has Been Signed on 03/30/2022 11:05 AM - It Cannot Be Edited

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:JACKSON, LOVELY FAMILY CHILD CAREFACILITY NUMBER:
543910940
ADMINISTRATOR:JACKSON, LOVELYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-8136
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:14CENSUS: 9DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lovely JacksonTIME COMPLETED:
11:30 AM
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On 3/30/2022, Licensing Program Analyst (LPA) Theresa Marquez conducted a complaint inspection and met with licensee, Lovely Jackson. Assistant Dionshynee Darby was also present.

During the course of the complaint investigation, it was revealed that Jackson failed to report to Community Care Licensing office an unusual incident. Jackson stated she failed to report the incident because the facility was temporarily closed when the incident occurred.

LPA Marquez reminded licensee that she is to report to the Fresno CCL office any unusual incidents per Title 22, Reporting Requirements regulation 102416.2, even if her day care home is temporarily closed.

No deficiency was cited today.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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