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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103809921
Report Date: 12/06/2022
Date Signed: 12/06/2022 12:36:18 PM

Document Has Been Signed on 12/06/2022 12:36 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:ARAGON, MARTHA FAMILY CARE HOMEFACILITY NUMBER:
103809921
ADMINISTRATOR:ARAGON, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 801-1153
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Martha AragonTIME COMPLETED:
01:30 PM
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On 12/6/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with licensee, Martha Aragon and a census was taken.

The purpose of the inspection is to clear deficiencies that were previously cited on 8/2/22. The LPA reviewed staff files and found all required forms and information to be in each staff's files. The LPA also observed children's files to have all immunizations updated and transcribed.

During today’s inspection, LPA provided the licensee a Letter of Deficiency Citations Cleared. An exit interview was conducted with Martha Aragon. Per Chapter 3, 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 licensee, Martha Aragon. 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.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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