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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801861
Report Date: 03/10/2023
Date Signed: 03/10/2023 03:51:17 PM

Document Has Been Signed on 03/10/2023 03:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-ERICSONFACILITY NUMBER:
103801861
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:4774 E. YALETELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 13DATE:
03/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mee MouaTIME COMPLETED:
03:45 PM
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On March 10, 2023, Licensing Program Analyst (LPA) Anita Tristan and Licensing Program Manager (LPM) Brannon conducted an annual inspection. LPA met with Lead Teacher Mee Moua. LPA arrived at facility and attempted to review children's files. Due to the lateness of the day, LPA will continue with annual inspection at a later day.


No deficiencies cited during today's inspection.
A Notice of Site Visit was provided and to be posted for 30 days. If not posted, a $100 civil penalty will be assessed.
Exit interview conducted with Lead Teacher Mee Moua.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023
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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