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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808143
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:02:00 PM

Document Has Been Signed on 09/29/2022 01:02 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:MADISON ELEMENTARYFACILITY NUMBER:
103808143
ADMINISTRATOR:WENDY HERNANDEZFACILITY TYPE:
850
ADDRESS:330 S. BRAWLEYTELEPHONE:
(559) 276-5280
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 2DATE:
09/29/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Roxanna QuinterosTIME COMPLETED:
01:30 PM
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On 9/29/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Roxanna Quinteros and toured the facility. A census was taken and there were two children present.

The purpose of todays inspection is to clear deficiencies that were previously cited on 9/13/22. LPA observed keep out of reach items to be placed up and out of reach, fire drills were documented and the facility license was posted where it is visible. The director stated that the large area rug is being replaced and that a new rug was ordered. The LPA observed the playground to have new fencing along one side and fencing across the open area behind the shed, so that it is blocked off. LPA further observed the holes threw out the play ground, and on the grass area, to be filled. LPA reviewed staff files and required immunizations were in each staff file.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. Exit interview was conducted with Roxanna Quinteros. Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, no deficiency was cited during today’s inspection.

A copy of this report and LIC 9213 Notice of Site Inspection were provided to the Site Supervisor, Roxanna Quinteros. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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