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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103906120
Report Date: 10/03/2023
Date Signed: 10/03/2023 10:44:07 AM

Document Has Been Signed on 10/03/2023 10:44 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MCINTOSH, SHANNON FAMILY CHILD CAREFACILITY NUMBER:
103906120
ADMINISTRATOR:MCINTOSH, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 970-2561
CITY:RIVERDALESTATE: CAZIP CODE:
93656
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/03/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shannon McIntoshTIME COMPLETED:
10:45 AM
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On 10/03/2023, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced Case Management inspection at facility. LPA met with Licensee Shannon McIntosh and took a census. The purpose of the inspection was to inspect a bedroom, Bedroom #1, to add to the license for day care use.

LPA inspected Bedroom #1 and observed a twin size bed and children's toys in the room. There is a closet with a safety latch installed out of reach of children which will remain locked during day care hours. There are safety covers on all electrical outlets. The room is clean and free of hazards.

Bedroom #1 was added to facility sketch and is approved for day care use as of today's date.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Candis Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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