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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
103810105
Report Date:
09/26/2023
Date Signed:
09/26/2023 03:19:50 PM
Document Has Been Signed on
09/26/2023 03:19 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:
JACK & JILL'S EARLY CHILD DEVELOPMENT CENTER, INC
FACILITY NUMBER:
103810105
ADMINISTRATOR:
GRAVES, EARLINE EVETTE
FACILITY TYPE:
840
ADDRESS:
969 S WILLOW AVE
TELEPHONE:
(559) 255-8817
CITY:
FRESNO
STATE:
CA
ZIP CODE:
93727
CAPACITY:
55
TOTAL ENROLLED CHILDREN:
55
CENSUS:
7
DATE:
09/26/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Earline Graves
TIME COMPLETED:
03:30 PM
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SUPERVISORS NAME
:
Cynthia Brannon
LICENSING EVALUATOR NAME
:
Julie Baptista
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/26/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/26/2023
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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